L-shaped Silicone in My Nose, But Want to Get Rid of the Hard Tip?

While your nose is not at any immediate danger, it is likely that at some point you will require revision surgery.  Since silicone is a foreign material, it doesn't become incorporated into your body.  It will continue to put pressure on the skin of your tip and thin it.  

L-shaped silicone implants are a quick and easy way to get a more projected (taller), more refined nose.  The problem that you are starting to encounter is a common one for many patients that have rhinoplasty with an L-shaped implant.  Unfortunately there is a risk of extrusion and infection of the implant.  When the skin overlying the implant thins to the point of extrusion, it must be removed asap.  In your situation, there's no need to panic since that has not happened, but the best option is to replace the silicone implant with your own tissue.  You will be able to achieve the shape you want, without people noticing you had work done.  

Most patients with a silicone implant have a hard tip.  Some will have thinning of the skin and extrusion. But many do not. So leave it alone for now and it may never progress to extrusion.

I always feel like these implants are either excellent and cause very little trouble, or they are bound for a real problem.  It sounds as though you need an evaluation to see if things are going well or if they are headed for an extrusion.  Sometimes, you just have to wait and see.

Revision Asian Rhinoplasty is a very common request in my practice, and I frequently have patients who have had implants placed in their noses in the past by another surgeon.  Many of these patients are unhappy with the unnatural appearance and seek my help to revise their noses by removing the implant and rebuilding their noses with their own cartilage. I prefer to use your own cartilage because the results are natural appearing and balanced with the rest of your face.  Please consult with a board certified specialist who can assist you in achieving the results you seek.

L-shaped implants are associated with problems of the overlying skin, late stage infections and extrusion. But you don't have to panic yet. You can consider modifying the tip with softer cartilage grafts which give a more natural look.

  I have dealt with these L-shaped silicone nasal implants many times over the past 22 years and IMHO, the L-portion should be removed ASAP.  This section, of the implant, creates the hard sensation in the nasal skin just above the nasal tip and in a large percentage, of the cases, can actually erode through the skin within 15 years of placement.  A Closed Rhinoplasty to remove that section should do the trick. 

If your l-shaped silicone implant does not look natural it can be removed. However I suggest you have the implant replaced with your own cartilage so you can maintain the shape that you like. Over the last 35 years I have seen problems with these implants which I avoid. However if there is not significant thinning of the tip at this time you can delay replacement. 

Hi,

Whether it extrudes or not depends on how much tension there is on the tip. It also depends on how well the implant was put in. However, if you do not like the way the tip looks or feels, you may want to consider a revision. I do not use pre-formed L shaped implants for that reason. A better implant would be a a custom carved implant and cartilage for the tip.

Best,

Dr.S.