Your Questions
Your Questions
Q: Dr. Eppley, I have had a silicone implant in my nose for 6 years. No major problems yet. Just pressure in the bridge area. Will the bone under the nasal implant resorb?? Was thinking about removing the implant because I don’t want to lose what bone I have in the bridge area. I am half Korean and half Caucasian with a relatively flat bridge without the implant. Thanks.
A: Bone resorption under a silicone nasal implant is very rare…to the point that I have never seen it or have seen it documented in the medical literature. (but that may be because x-rays are rarely taken of the nose to look for it) The likely reason is that of the three elements involved in this equation, an unresorbable silicone implant, hard bone and a thin overlying soft tissue cover, the weakest link is what lies above the implant. Rather than the bone resorbing underneath the implant, the overlying soft tissue thins in response to any pressure caused by the implant. Whether this will actually happens depends significantly on the size/thickness of the nasal implant and its durometer. (measure of its hardness) In conclusion I would not remove the nasal implant because of any fear of bone resorption. Be aware also that your nose will look flatter than before having the nasal implant because the overlying skin has gotten stretched and is now thinner as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve been browsing your website for a couple of weeks and it has proved a tremendously useful resource on rhinoplasty. This is something I’ve been thinking of getting for a while, but I would like your opinion on the options available. From what I’ve read, silicone implants tend to come with a risk of extrusion, which is why many surgeons recommend rib grafts. However, I would prefer to avoid the scar and a more invasive procedure. After posting on various forums, I have been recommended to get a silicone implant for the bridge, but to use ear cartilage to reinforce the tip and to further build up the bridge and radix. Do you think that this will be a viable alternative to rib grafting? Lastly, as I’m from out of the state, would you be able to perform a rhinoplasty on me, and how long should I expect to have to stay before flying back home?
A: It is understandable that many patients want to avoid the use of a rib graft for their rhinoplasty. The use of an implant makes the operation far less complex and much easier for recovery. But, as you have pointed out, the use of an implant for nasal augmentation must be carefully done to avoid its well known complications. For implant nasal augmentation, I currently prefer the use of a PTFE-coated silicone implant as it allows some better tissue adhesion than pure silicone alone but avoids the severe scar adherence of a Medpor implant. The key to prevent long-term complications is to avoid too much pressure on the overlying skin, particularly that of the tip. For this reason, many surgeons will cover the tip with an ear cartilage graft which is a perfectly valid approach. When possible, I prefer to place the end of the implant under the nasal dome cartilages which have been lifted, narrowed and sewn together over a columellar strut cartilage graft. This achieves the same purpose but buries the implant under more natural tissue. This can only be done when the nasal implant is a dorsal style only and not a dorso-columellar style implant. Many times the dorso-columellar style can be avoided with columellar strut grafts. It is unclear to me yet as to what your nasal augmentation needs are.
With a rhinoplasty that uses a nasal implant, the recovery is only a matter of days until one can return home.
Dr. Barry Eppley
Indianapolis,Indiana