Rhinoplasty silicone in bridge and tip plasty, bridge silicone shifts to the side and tip droops down?

Question

So I have read that silicon in the bridge can shift to the side or up and down. And the tip eventually droops? I don't really understand why the tip can drop down. If it because the cartilage that extends the tip forwards moved down? And the bridge, is it because you slept on one side all the time? Touched it frequently? Please explain it to be in detail so I can understand their situation.

Toby Mayer, MD · Answer

Silicone implants used in the nose can shift because they are a foreign substance and never incorporated into the body. Cartilage will be incorporated into tissue and therefore does not move and you do not have that problem  and you do not have the infection problem that you have with silicone when cartilage 's used.

Kenneth Hughes, MD · Answer

Any type of graft or implant has the potential to shift.Kenneth Hughes, MDLos Angeles, CA..............

Danny Soares, MD · Answer

Out of all of the possible implants that can be placed over the nasal bridge, silicone implants are probably the least ideal. The nasal dorsum is convex, offering a potentially unstable base whereupon to stabilize a synthetic implant. In addition, silicone implants do not allow for tissue ingrowth and heal in place by capsular formation, which can more likely lead to implant deformation and warping. In addition, because there isn't a firm support base and no possibility for implant tissue ingrowth, silicone implants can more easily shift up and down. In addition, because of the thin overlying skin, the implant can also can begin to extrude at any point following surgery, sometimes even many years after placement, such as after minor trauma to the nose. The position of the tip will only be affected if the implant was to push into the tip and cause it to rotate. Most surgeons will agree that the best graft for your nose is septal cartilage, followed by ear or rib cartilage. If, for some reason, obtaining the cartilage is prohibitive to you or deemed not worthwhile, irradiated cadaveric costal cartilage is also available. If you must choose a synthetic implant, Gore-Tex (expanded polytetrafluoroethylene, ePFTE) is probably the most ideal for nasal augmentation presently. ePTFE is microporous and allows for some tissue ingrowth that both stabilizes and protects the implant. It is also very durable, non-reactive, and can be more easily removed than other porous implants. Best of luck to you!

Stephen Weber MD, FACS · Answer

Silastic implants can shift or in rare cases work their way through the skin of the nose. This is the reason why cartilage grafts are used in most cases to rebuild or augment the nose. With regard to the tip drooping, an implant on the bridge should have no bearing on the tip position. Drooping of the tip usually occurs if an inadequate amount of tip support is created during surgery or if the existing tip structure won't support the tip during the healing period. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Michael T. Somenek, MD · Answer

I'm not sure if you are referring to a silicone nasal implant or silicone injected into your nose to fill in certain areas. If you are referring to a silicone implant, there is always the possibility that it can shift if not placed in a tight pocket. There are other reasons why an implant moves and can range from trauma to infection. Depending on how the implant is placed will determine the ramifications it will have on the nasal tip. Some implants have an extension that provides tip augmentation simultaneously. In any case, if you are considering augmentation to your nasal bridge, I would encourage you to use autologous tissue which means cartilage and soft tissue from your own body. There is a lower incidence of infection and is equally effective to create the look you want with less risk involved. If you are seeking a rhinoplasty, make sure you go to a rhinoplasty specialist so you are able to explore all your options.

Richard W. Fleming, MD (retired) · Answer

While it is easier to place a silicone implant to augment the bridge movement is a post op risk because it does not firmly attach to the surrounding tissue the way your own cartilage integrates with your normal nasal structures. Over the past 35 years I've avoided the use of silicone in the nose.

Ronald V. DeMars, MD (Retired) · Answer

Your question is correct but the problem is infrequent. To a large extent it depends on the surgeons technique.

Rhinoplasty silicone in bridge and tip plasty, bridge silicone shifts to the side and tip droops down?

Answers (7)

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