What are my options for liquid silicone removal from my nose?

Question

Had my 1st rhino 6 yrs ago that resulted in a number of issues. My doc resisted a revision and tried to fix the issues with liquid silicone. We only did one session where he put a little at the tip of my nose and on the side of my bridge. I didn't know these fillers were permanent. I experienced swelling thereafter and dissatisfaction with my nose still. I had to get a revision (2.5 yrs ago) but I'm still experiencing swelling. Is it because of the silicone? What are my options to mitigate this?

Jeremy S. Nikfarjam, MD · Answer

Hi LoveRoses,
Your situation is unique! You need sub-sub specialist care- someone who specializes in revision rhinoplasty and silicone removal. I see both in my practice. Silicone is permanent and can cause ongoing swelling. Some patients see cycles of these "flare ups" that can be occasional and seemingly random, or sometimes progressing to very frequent or chronic. 
If I were consulting with you, I'd suggest a CT scan of the area to try to identify whether there is indeed any foreign body (silicone substance) present. You might then be a candidate for a revision rhinoplasty and silicone removal. 
Please feel free to reach out to my team here and we can set you up for a complimentary virtual or in-person consultation. Many silicone removal procedures are covered by a patient's health insurance. 
Best of luck in your search for treatment!
- Dr. Nik

Raffy Karamanoukian, MD, FACS · Answer

Silicone biopolymers are commonly used in the face and body. They may sometimes cause noticeable symptoms that we gauge using the Karamanoukian Soft Tissue Reaction Grading Scale from I to V. The severity of your complications dictates the interventions needed, ranging from itching and burning to severe necrosis of the soft tissue. Nerve pain and symptomatic swelling is also possible. Insurance may cover your surgery, but that is a discussion that requires you to contact and appeal to your insurance carrier. Options for removal are complex and depend on whether you have the material in your face or body. We reverse BBL with silicone commonly and remove silicone from the lips very commonly. Diffuse silicone in the face is not likely to respond to removal. Filler migration, swelling, and granulomas can cause significant discomfort and cosmetic ramifications. Our office specializes in the use of enzymes and filler reversal techniques without hyaluronidase to help improve the results of botched cosmetic fillers, whether caused by Juvederm, Restylane, or foreign fillers. We can also test for the material to determine the likelihood of silicone granulomas and silicone reaction.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding what to do for the removal of liquid silicone injections for elective nose surgery or rhinoplasty. I'm sorry you're having these problems. Unfortunately, it is very difficult to remove silicone from the nose. Therefore, in my opinion, I think most of the remaining problems you have such as swelling, redness, and possibly pain are due to the remaining silicone in the nose. Therefore, I would suggest that more silicone be removed from the nose. Before surgery, I would suggest an MRI of the nose to determine if silicone remains and where the silicone is located. Please seek an experienced board-certified plastic surgeon who has experience in removing silicone from the nose.

I specialize in silicone removal and subsequent facial reconstruction. I am the Director and chief clinical investigator at the Institute of Silicone Removal. Since removing silicone from the forehead is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience in removing silicone from the face. Do your research. Make sure they have performed at least 100 silicone removal surgeries and have the before and after pictures to prove it. Carefully examine their before and after pictures and check their reviews on RealSelf. If you cannot find an experienced, silicone removal surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen (“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, Certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Praful Ramineni, MD · Answer

Silicone can be removed from the nose with an open rhinoplasty.  This can often be replaced at the same time with cartilage.

What are my options for liquid silicone removal from my nose?

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What are my options for liquid silicone removal from my nose?

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Everything you need to know about Silicone Injection Removal

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