What is Alternative to Silicone Implant? Rib Cartilage Safe?

Hi, I got my rhinoplasty about a year ago in another country but i have been seeing redness and white color near 2mm is silicone placed in my nose bridge. I am considering to go back for re surgery, I want to take out silicone and replace it with something. What is another SAFE options? I used ear cartilage already for my tip, can i use rib cartilage on my nose bridge? do i even need one since it was 2mm? What is the cons of using rib cartilage on the nose bridge? Thank you!

Doctor Answers 12

Alternative to nasal silicone implant

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There are many alternatives to augmenting the nasal bridge.  Septal cartilage is always the first and best alternative in augmentation rhinoplasty.  If the nose has been cartilage depleted then attention is directed to ear cartilage for use of auricular cartilage to build up the bridge.  Rib cartilage is an acceptable alternative as well, but is very stiff and tends to warp over time.  The best synthetic implants are silastic implants.  

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Rib cartiage

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Any procedure carries risks, the goal of the surgeon in conjunction with the patient to balance the relative incidences of the risks with the potential benefits of the procedure. Having said that if your implant is infected , ie red and swollen, it will require removal. The type of augmentation is related to the size of the augmentation . So one of the key factors in your situation would be to determine the height and length of the augmentation.

Silicone nasal implant still best

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If you have can L-shaped silicone nasalnimplant, they create redness and can even erode through the skin. For those reasons, they have been replaced with straight silicone nasal implants. It's the L section that creates pressure on the skin. When patients come to me with that implant, I trim back and remove the L section which reduces the pressure point on the nasal skin and reshape the tip with a conceal cartilage ear graft. I have performed Rhinoplasty for over 20 years and IMHO, bone, cartilage, rib cartilage and banked (irradiated) ear cartilage all dissolve unevenly over years making them unreliable for long term nasal implants.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Alternative to Silicone Nasal Implantt

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It is not an emergency, but I recommend removing the implant in the near future; the white patch you're seeing is the silicone implant under very thin skin. If this extrudes, you'll have to deal with a scar in the nasal skin. You can then consider alternatives to augment your dorsum if that is necessary. This is why I don't recommend silicone implants - I've seen this too many times over the last 35 years.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Rib best alternative to silicone implant

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using your own rib (not irradiated rib) is the best and safest long-term option for replacement of a silicone implant - you can also remove the implant and see if you like the look of the bridge without anything

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Rib cartilage is very safe for rhinoplasty and can give you a lifetime solution

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Rib cartilage is very safe as long as it is performed by a surgeon who does it frequently.  If the surgery heals well, you will have a permanent new nose.

The problem with rib cartilage that all surgeons have is that it has strong internal stresses and can sometimes deform after surgery.  The chances of that happening depends on patient age: older is better. I perform rib grafts frequently on badly damaged noses but still need to revise about 9% of my cases if the patient wants the best result I can provide.  All of us who perform mostly rhinoplasty have the same problems with living human tissues, which is why some surgeons use silicone.

Find a surgeon whom you trust and who can show you results of other patients with similar deformities that you like.  Good luck!

Mark B. Constantian, MD, FACS
Nashua Plastic Surgeon

Rhinoplasty and rib cartilage

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It sounds like the silicone implant is under very thin skin. I am not a fan of silicone implants, as there are some very bad complications associated with silicone. I would recommend seeing a revision rhinoplasty specialist for a consultation. They may recommend removing the implant and replacing it with rib cartilage. While I feel that it is a better option, there are still complications associated with rib grafts that you can discuss with your surgeon.

Ryan Greene, MD, PhD
Fort Lauderdale Facial Plastic Surgeon
5.0 out of 5 stars 85 reviews

Macroplastique for nasal augmentation

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It sounds like your implant is about to extrude - which is not uncommon.  You should see a plastic surgeon as soon as possible.  As an alternative, Macroplastique is a wonderful material for dorsal augmentation.  It is placed by injecting and is permanent, like silicone, but does not have the problems that solid implants do.  Although FDA approved for injection around the bladder, it has shown great success when used in other areas.  Be sure you seek a surgeon with experience using Macroplastique for nasal augmentation.

Randy J. Buckspan, MD
Austin Plastic Surgeon
4.6 out of 5 stars 10 reviews

Replacing silicone nasal implant on bridge

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Using your own rib cartilage is a very good alternative to using a silicone implant. Since it's your own tissue there isn't the same issue of rejection that can occur with silicone.

Issues to consider with rib cartilage is that of carving the implant properly to prevent warping. In experienced hands this risk is quite low. A great thing about rib cartilage is the abundant supply of very strong cartilage it provides for any number of nasal problems, including rebuilding the bridge.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

There are a number of alternatives to build up the nasal profile in rhinoplasty

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Solid Silicone, called Silastic, has been used for many decades to build up the bridge of the nose. Unfortunately, it has a tendency to become infected from months to years later. There are a number of alternatives. Another synthetic is Goretex. Using your own cartilage, such as nasal septum or ear cartilage is also useful.

In my opinion, for a very scooped nose, rib cartilage is the best alternative. It can be used as a solid block or diced and wrapped in a layer of fascia, which is the covering of a muscle from your temple. To get a millimeter or two augmentation, you can dice the cartilage from one ear and wrap it in the fascia for a subtle enhancement of your profile.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 141 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.