What is Alternative to Silicone Implant? Rib Cartilage Safe?

Question

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!

Sam Naficy, MD, FACS · Answer

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

Thomas A. Lamperti, MD · Answer

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.

Steven J. Pearlman, MD, FACS · Answer

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.

David C. Pearson, MD · Answer

I'm not a big fan of silicone (Silastic) in the nose or even Gore-Tex since these can extrude or become chronically infected. It sounds like yours may be in the process of extruding.

	Rib cartilage is the next best option especially when a lot of material is required, but even when very little is needed. It does require the creation of a small scar on the right side of the chest and carries with it more initial post-op pain. The graft has to be cut very carefully to avoid later warping, though, which is probably the greatest problem with rib grafts in rhinoplasty. Lately, there has been a resurgence of the use of irradiated cadaver rib cartilage which avoids taking the patient's own rib. Depending on where and how they're used, though, rib grafts can resorb to some degree over time.

	All the best,

	--David C. Pearson, M.D.

William Portuese, MD · Answer

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.

Ryan Greene, MD, PhD · Answer

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.

Mohsen Tavoussi, MD, DO · Answer

There are several alternatives to silicone implants some are synthetic such as Gortex others could be your rib cartilage which causes a scar and is very painful procedure and can warp. . Cranial bone graft can also be used and is less painful ( virtually painless ) but needs to be done by surgeon experience in harvesting this graft. Cadaver rib cartilage is readily available and has been used for over 30 years with good results. I will have to say that I have used silicone implants for 20 years and the complication rate has been comparable to any other graft. It has to be placed in the right place in the right individual.

Jay M. Pensler, MD - Account Suspended · Answer

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.

Mark B. Constantian, MD, FACS (retired) · Answer

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!

Randy J. Buckspan, MD (retired) · Answer

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.

What is Alternative to Silicone Implant? Rib Cartilage Safe?

Answers (12)

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