I saw a patient today in consult that prompted me to write about nasal implants. She is a Chinese female that had a rhinoplasty performed in her country about two years ago. She arrived in the United States as an exchange student six months ago here in Miami. About four months ago she started to feel a bump in the tip of the nose. She ignored it for the next three months.
She arrived at my office today with a large protrusion on the tip of the nose. She never felt any pain and it took her some time to realize that this bump was a consequence of her cosmetic rhinoplasty. She was prompted to come in for consultation when her best friend, who had had a previous rhinoplasty, told her.
As soon as I saw her, I realized that this was going to be a problem and that I should blog about this to help prevent this from happening to others. On examination, she had a solid silicone implant extruding right through the skin. She actually had two implants placed. One dorsal implant on the bridge of the nose to add height and a second one on the columella of the nose to give it support.
So the question is “ why did this happen?” Well there are various factors here. First and foremost, synthetic implants placed in the columella during a rhinoplasty do not hold up well. The columella is an area that does not take implants well. Only cartilage grafts should be placed here. Second, solid silicone implants are not the ideal implants for the nose. Ideally, cartilage and soft tissue grafts are the best that can be utilized in rhinoplasty. Cartilage can be harvested from the septum, ear, or rib. Soft tissue implants can be obtained form the post-auricular SMAS, dermal fat graft, or temporal-parietal fascia. I occasionally use synthetic implants in the nose. This is a rare occasion and usually for special circumstances. When I do, I am very careful when I select the patient. I only use a Gore-Tex, a synthetic material that allows the tissues to grow into it. This tissue in growth helps to keep the implant in place and prevents infection. This makes it a relatively safe implant with a very good safety profile.
In conclusion, it is always better to use one’s own tissues when performing a rhinoplasty or a revision rhinoplasty. Sometimes, for a variety of reasons, septal and ear cartilage may not be available. It is in these cases of rhinopasty that the careful and judicious use of a synthetic implant can be seriously considered.