Nasal dorsal silicone implants probably have a lower incidence of extrusion than the "L" type struts that rest under thin nasal skin. However cartilage has proven to be better.
Provided that the amount of dorsal augmentation is not too much, silicone dorsal implants have a much lower incidence of complications than that of L-shaped implants as you have corrected surmised. (tip skin thinning) Unlike the rest of the face, the nose has a much more limited tolerance for synthetic materials. But if just limited to the dorsum and does not put a lot of pressure on the overlying skin, it can be very well tolerated with good long-term effects.
Both of these options can thin the skin and become palpable and visible. There is less infection and extrusion risk with cartilage grafts.
Kenneth Hughes, MD
Los Angeles, CA
We see a lot of ethnic patients who believe that silicone implants in the nose are the best answer but oftentimes it is not only a problem of long term skin thinning and possible extrusion but also the more immediate problem of an unnatural look.
Depending on what ethnicity you are, your skin thickness, as well as your goals a good rhinoplasty surgeon will be able to go over all the risks and benefits of the various options. In our own practice, we often will use irradiated donor rib cartilage in patients who want and need significant dorsal augmentation and have had wonderful results. Moreover, the long term studies looking at irradiated rib cartilage show that it works at least as well as your own rib cartilage if not better. So we'd recommend you look at all your options.
All the best,
Peyman Solieman, MD
I will typically choose cartilage grafts over synthetic implants in the nose when possible. Unless you've had previous nasal surgery, you can usually obtain enough cartilage from inside the nose or the bowl of the ear to achieve augmentation of your bridge without resorting to rib cartilage or synthetic implants.With regard to longevity of silicone implants, they will last a lifetime as they are not reabsorbable. With that said there is always a risk of infection with silicone implants as well as extrusion as you mentioned. Seek a consultation during which you can discuss your specific concerns and receive detailed advice about what would work best for you. I hope this information is helpful for you.
Stephen Weber MD, FACS
Denver Facial Plastic Surgeon