Your Questions

Q: Dr. Eppley, I have heard that chin implants cause bone resorption.  If this is true do they cause resorption under silicone nasal implants too?  My nasal implant only extends to the dorsum.  Also, how does one know if nasal implants cause scar tissue in the nose bridge?  Thanks. 

A: Silicone nasal implants do not cause bone or cartilage resorption of the underlying nasal structures. Chin implants settle into the chin bone because of the pressure and contraction of the overlying mentalis muscle. This is not active inflammatory resorption but simple passive settling of the implant a millimeter or two into the bone for a pressure release. It is a self-limiting problem whose concerns about it are way overblown. A nasal implant is placed under the skin and is not exposed to the same pressure phenomenon. In nasal implants the potential is not for bone or cartilage resorption but thinning of the skin over if they are big enough.

All implants placed in the body form scar tissue around them or become encapsulated. This is normal and occurs no matter where or what type of implant is placed, including nasal implants. This is a normal bodily response to an alloplastic (synthetic) material)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I read your article on natural vs. artificial implants in rhinoplasty.  I was wondering why you prefer natural material. I also know diced cartilage wrapped in fascia has been offered fairly recently.  Do you know if this is a fairly new procedure or if this has been offered since 2009?  I am considering tip revision but also want to keep my bridge area in mind if need be.  I have an implant in my nose as mentioned earlier but do not know if these implants last a lifetime. I had mine placed when I was 38.  Is there some kind of average, for example, 20 or 30 years?  Thanks.

A: Significant nasal augmentation in rhinoplasty can be done with either nasal implants, usually made of silicone, or rib cartilage. There are advantages and disadvantages with each type of implant/graft and both can have successful long-term results. Silicone nasal implants never change in shape or structure, can not degrade or break down and never need to be replaced because they fail. The issue with any synthetic nasal implant is that the tissues change around them in some cases (if they are big enough) and this means that the skin over the implant thins. This can lead to potential long-term issues such as implant show, exposure or infection. This never happens with cartilage grafts which is why they are preferred in larger nasal augmentations if one is willing to invest the greater effort up front.(longer surgery, scar, expense)

The use of diced cartilage wrapped in fascia or surgical in rhinoplasty is not new and has been around for several decades. It s biggest advantage over en bloc or solid rib grafts is that there is no potential for warping or edging. They can be used to cover a nasal implant particularly in the tip area. But the use of ear cartilage would actually be better for this purpose.

Dr. Barry Eppley

Indianapolis, Indiana

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, do you feel it is possible to create an aesthetic male face even with my Class 1 hypertelorism? I understand that it can be found to be an attractive feature in women (such as Jackie Kennedy), but I can’t really seem to find any examples of good looking male face with hypertelorism. Do you know of any? Thanks!

A: First degree hypertelorism, as you have been mentioned, can be attractive in females. You have mentioned Jackie Kennedy as an historic example but Uma Thurman would be a more recent illustration. When it comes to men, however, I have never heard it so described and can not think of any example where it is.

The spacing between the eyes can be improved by several facial camouflage strategies. I have not seen a side view of you so I can not say how successful they would be in your case. Building up the bridge of the nose, usually with an implant,  is a classic example of decreasing the distance between the eyes. This is best done in patients that have a low or wide nasal bridge. The higher the nasal bridge, the less the eyes look far apart. In addition, widening the lower face can also help camouflage it. Cheek and jaw angle implants in particular help widen a the lower 2/3 s of the face.

Dr. Barry Eppley

Indianapolis,Indiana