Q: Dr. Eppley, I was 16 years old when I got my rhinoplasty done. I am Asian and I had what appears to be a very typical Asian rhinoplasty using an implant. I think it is a silicone L-shaped implant. I originally had a very flat nose with a low bridge. It is now 20 years later and I want to take it out. I have never liked the way it feels and the idea of having plastic in my face bothers me. I think the skin has also gotten thin over it as I think I can see the implant when out in bright sunshine. Can it be removed at this point? How will my nose look when it comes out?
A: Your indwelling nasal implant can be removed at any time. The question is not whether it can be removed but whether to do anything else to replace it at the time of its removal. Taking the implant out will deflate the nose so it will get flatter and shorter, perhaps close to what you were before. Certainly that is the easiest option but perhaps not the most esthetic. Replacing it with a rib cartilage graft is the most aesthetic but not the easiest. Intermediate options include placing layers of allogeneic dermis (e.g., alloderm) on the dorsum and a septal columellar strut graft. That would be a good revisional rhinoplasty compromise as it would produce an intermediate aesthetic result without the need for rib graft harvesting. I suspect you really won’t like the appearance of the nose when the implant is removed but may not really want to have a rib graft harvested either.
Dr. Barry Eppley
Q: I have been researching for the options to remove the silicone on my nose bridge. I saw some chat group people talking about Korean plastic surgeons removing injected silicons from the nose bridge from inside of the nostrtil and implanting a new bridge at the same time, supposedly leaving no visible scar left after the surgery. As far as I have seen, this approach seems like only available in South Korea, Thailand and Singapore so far. What is the feasibility of using this method in U.S? Will this be easier than accessing the injected silicon from behind the hair line? I will continue to search options. Hope I will not have to go overseas to remove the little piece of silicon. Thank you very much for your time and consideration.
A: What is not clear in your inquiry is whether the silicone that in on your nasal bridge is a solid implant or is from silicone injections. Furthermore, I am assuming when you say nasal bridge you are referring to the length of the nasal dorsum as opposed to just the nasal bone area at the upper one-third of the nose.
Regardless, a nasal approach to its removal would be certainly be preferable and easier. Whether this is best done through a closed or open rhinoplasty approach is not clear just based on the information you provided. I see no reason or benefit to using a superior or scalp approach for its removal.
Immediate replacement with another nasal dorsal implant, if desired, could also be done at the same time as well.
Dr. Barry Eppley