Is my L shaped implant extruding? If so, how soon do I need to get a revision? What is the downside of using rib grafts? (Photo)

I had rhinoplasty done about 7 years ago and my surgeon used an L shaped silicone implant. Should I be concerned with this bump? It the implant extruding?

Doctor Answers 9

Revision Asian Rhinoplasty

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Unfortunately silicone in the nose cannot stay permanently and will need to be removed at some point.  Since it is a foreign body it never becomes a part of your nose and instead continually thins the skin around it.  This can eventually cause a break in the skin, leaving an exposed implant.  

The issues you had with the redness in your tip and the extrusion of your implant may be reduced with the use of tissue from your own body (autologous grafts).  Autologous grafts have a much lower rate of infection and migration because they become incorporated into your nose and fully become a part of it, instead of remaining as a foreign body like Silicone and Gore-tex grafts do.  It is possible to achieve significant refinement and augmentation with autologous grafts just like synthetic grafts.  

An Asian rhinoplasty specialist, experienced in revision cases, will best know how to remove the implant and reconstruct your nose.  Your nose can be reconstructed with tissue from your own body, giving you a permanent result.  

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 64 reviews

Is my L shaped implant extruding? If so, how soon do I need to get a revision?

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 Hi, I have performed many Rhinoplasty Surgeries over the past 30 years.  From the photo, the L-shaped implant is thinning the skin over the nasal tip.  The sooner this is removed the better.  I typically, remove the vertical segment of the L shaped implant and leave the horizontal portion and the dorsal augmentation that it provides.  If required, a conchal cartilage ear graft can be used to repair or add support to the nasal tip.

Hope this helps.

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

L shaped silicone implant versus rib graft

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You will sooner or later have to replace the silicone implant which will never become integrated into your tissues; if it is starting to protrude through your skin, it is time. You want to preserve your skin integrity when you do your rib graft. BTW we no longer harvest your own rib; we can purchase an organ donated rib which is stable and will provide you a stable construct. Please see examples below.

Arian Mowlavi, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 106 reviews

Extruding Nasal Implant

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The sooner you get a revision the better. The implant is causing irrevocable damage to your nasal tissues. Rib graft is your only good alternative to achieve the same result your L implant gives you: dorsal augmentation AND tip projection and nasal length.  Ear and septal cartilage are too weak and too short. Proper shaping of the rib will significantly reduce the risk of warping. Go visit a few ABPS certified/ASAPS member surgeons that specialize in rhinoplasty. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Revision rhinoplasty: extruding implants

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Synthetic implants can extrude at any time, even if you've had no problems for many years. Early signs are mobility, redness, swelling, and thinning skin. It's best to be treat it before it breaks through the skin. 

The implant needs to be removed. It can be replaced with your own cartilage. If the implants is large, you may need a rib graft. The downside with rib grafts is the risk of warping. Your surgeon needs to be familiar with carving cartilage for a safe and happy result. Safety comes first. 

Victor Chung, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Is My Siicone Implant Extruding?

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It does appear that your L-shaped implant is extruding beneath the thin skin of your tip. I don't want to sound like an alarmist but I would consult with your surgeon or an experienced revision specialist as soon as is reasonably possible because you don't want the implant to break through the skin which could result in unfavorable tip scarring. Over the last 35+ years I've very rarely found that rib grafts will be necessary in a patient like you; usually adequate cartilage can be harvested from the septum and ears to augment the bridge and maintain tip support and definition after implant removal.

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

Extrusion of nasal implant?

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it appears that you may have a possible thinning over the implant. See a very experienced  revision rhinoplasty surgeon if your surgeon is not available. The implant can be removed and replaced with septal or ear  cartilage without needing a rib graft. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

L-shaped silicone nasal implants may result in extrusion at the nasal tip.

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If you're visualizing a bump and thinning of your skin at your infratip lobule, you could be starting to extrude your implant. Silicone implants work well in thicker skin types for elevation of the nasal bridge, but the L-shaped implants that extend down your columella are the ones that may extrude - typically by the tip. An examination by a revision rhinoplasty specialist may be helpful to see what might be best for you moving forward. Wishing you well. Dr Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews


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Thank you for the question and I would see your surgeon or other expert in the area and be evaluated.  That said it may be time to remove that implant and replace it with cartilage

Dr Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 65 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.