Why is silicone not used in Rhinoplasty?

Question

dear docs your advise is needed: why is silicone not used (much) in rhinoplasty these days instead of all that cartilage harvest? wouldn´t it cause much less problems to the patient since there will be: + no wounds + no healing + no deformity + no pain involved at the donor site? i know that silicone wont last forever but so do cartilage grafts not last forever. thanks for your advise

Alejandro Nogueira, MD · Answer

Cartilages DO indeed last forever once grafted and revascularized inside noses, who told you such idea? maybe a surgeon without skills or patience to build noses who is keen on using out-of-the-box nasal prosthesis?No one serious, reputed, efficient and capacitated surgeon would, IMHO, use nowadays silicone or goretex in noses, they do look very artificial, do extrude commonly, dislocate, get easily infected in early or late postop stages, etc (neither mattrices, dermal grafts, fillers, etc for identical or worse reasons).Cartilage grafting is unparalleled nowadays and ancient 80s or 90s disputes are cleared enought these times.

Eric M. Joseph, MD · Answer

There has been a fifty year history of permanence, precision, and safety using medical grade liquid injectable silicone for nonsurgical rhinoplastic treatments. Dr Richard Webster recorded his favorable twenty year experience with medical grade silicone for nonsurgical rhinoplastic revisions in 1986, and our experience over the last seventeen years with Silikon-1000 has been favorable and well-received by our patients who are candidates for nonsurgical rhinoplastic procedures.
Rubberized silicone implants may be considered for raising the nasal bridge during rhinoplasty surgery, usually in patients with thick, often ethnic skin types. Rubberized silicone implants may not be well suited for those with thin skin due to visibility and extrusion. When dorsal augmentationb is necessary in rhinoplasty surgery, we typically prefer ePTFE sheets from Implantech. Hope this helps. Dr Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. In my practice I prefer to use diced cartilage wrapped in fascia for dorsal augmentation in rhinoplasty.  Silicone has many issues including infection, malposition, and extrusion over time. 
Make sure you specifically look at before and after pictures of
real patients who have had this surgery performed by your surgeon and evaluate
their results.  The most important aspect is to find a surgeon you are
comfortable with. I recommend that you seek consultation with a qualified
board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Michael J. Yaremchuk, MD (license resigned) · Answer

Silicone is used mostly for dorsal augmentation (ie the bridge).  It has it’s place but most people require reduction not augmentation so it isn’t used often in the US.

Reza Momeni, MD, FACS · Answer

Injectible silicone is not FDA approved, but silicone implants are used often in rhinoplasty in the world, particularly in Asia.  The problem is that sometimes the silicone material extrudes (comes out) as a result of it not taking well in the body.  In the USA, for that reason, the implants have never been that popular except for very small niche practices.  Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.  I've attached a link where you can start your search.

Steven Wallach, MD · Answer

Free silicone should absolutely not be used, but silicone solid grafts are still used.  Cartilage grafts are often better because they have less of a chance of getting infected. Placing a silicone graft is certainly easier.

Victor Chung, MD · Answer

Rhinoplasty is a surgery to improve the shape of the nose for breathing or appearance.To build up the nose, many surgeons prefer to use cartilage over silicone. Yes, silicone is cheap, quick, and easy. It is used commonly in Asia. Implants carry a lifetime risk of infection and extrusion (breaking through the skin) with potential catastrophic collapse or deformity of your nose. Cartilage grafting takes more time and skill. The long-term benefit is that it is your own living tissue that heals and has the ability to fight infection. When it comes to your face I think safety is more important than quick and easy. Safety comes first.

William B. Rosenblatt, MD · Answer

It isnt used a lot because it is a foreign body that often ends up falling out. Cartilage is  your own tissue and it gets to become part of  your nose while the very thin tissues in your nose just don't accept the silicone and often it works it's way out.

David L. Cangello, MD, FACS · Answer

Hello and thank you for your question. We prefer to use cartilage grafts because the tissue is your own. Silicone is a foreign body. It has a higher chance of becoming infected and having other problems because it is never incorporated into the tissue the way cartilage grafts are. That's not to say silicone implants can't be used, or might not be acceptable in certain situations, but certainly it is safe to use a patient's own tissue for building the structure of the nose. Hope this helps.

Robert L. Kraft, MD, FACS · Answer

Free silicone has been the source of multiple problems which have been documented in the literature.  Silicone implants, as are used in the chin and other areas, are not well tolerated, resulting in complications.  Autologous cartilage taken from behind the ear, if necessary, has better outcomes.

Why is silicone not used in Rhinoplasty?

Answers (11)

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