Options after silicone removal

Allopastic implant is commonly used for dorsum augmentation in Asian countries. This is removed for various reasons; deviation, extrusion, foreign body reaction, and inflammation. When the allopastic implant needs removal, there are 3 options for the patient.

First, just remove the implant and wait. Further surgery on the nose is planned after all complications subsided. The best time is at least 6 months after surgery. This is a freqeuent option when alloplst was implanted within 1 year without any further manipulation of the dorsum and the tip.

Second, implant is removed and restoration of the nose to the preoperative status is done at the same time. Nasal hump removal, rasping of the dorsum for implant fitting, implantation years earlier, other manipulation of the dorsum and the tip needs additional maneuver to make the dorsum and tip look normal after implant removal. Commonly, remaining septal or conchal cartilage, periosteum, or fascia is used for this purpose.

Third, when patients love the current shape although implant needs removal due to complications, the volume of the implant needs to be filled with autogenous materials. Or when the patients want further improvement of the nose, various autogenous materials are neccessary including rib cartilage. Sometimes, using rib cartilage is the only option to satisfy this kind of patient.

Choosing among the above 3 options depends on the patient's wish, current nasal status, availability of the autogenous material, and surgeon's experience level.

Comments

Deviated & hump nose correction

This lady in below photos had nasal deviation, hump nose, and tip ptosis with breathing difficulty. Septum was corrected first, and this made the lower 2/3 of the nose straight. Hump was not resected but rasped with Piezotome and this did not breach the keystone area, which made spreader grafts unnecessary.Bilateral osteotomies with Piezotome made her bone straight. Together with septum correction and effective osteotomies, her nose became straight from the frontal view. Tip was modified with sutures and onlay graft only. No strut or septal extension graft was used and this made the tip soft even after considerable amount of rotation and projection increase. Radix was augmented with bruised cartilage. Overall, she could breath much better after surgery and her nose became more harmonious and feminine.

key to rib cartilage use in rhinoplasty

I had the joy to guest edit a special issue ' The key to costal cartilage in rhinoplasty' in journal 'Plastic and Aesthetic Research'. This special issue covers all issues of rib cartilage use in rhinoplasty; cutting edge techniques of harvesting and carving, application of rib cartilage in primary and revision rhinoplasty, practical points for proper preoperative and postoperative care, and diced cartilage and homologous cartilage applications. I invited world renowned rhinoplasty surgeons who are specialists in dealing with rib cartilage use. I hope rhinoplasty surgeons who wants to use rib cartilage in their practice will benefit from the wisdom of the experts.

Creating more feminine nose

The lady in below photos visited my clinic for rhinoplasty. She wanted to have more feminine nose instead of her muscline nose. She had a long nose with slight bump on the dorsum, overprojected, slightly bulbous and droopy tip, and slighly wide dorsum. Surgery was focused on creating more feminine look: hump removal, narrowing the bony dorsum with osteotomies, tip volume reduction, decreasing tip projection, and slight cephalic rotation. Photos taken 2 weeks after surgery (because she returnd back to her country after surgery) shows changes on the dorsum and the tip. Dorsum became slender with creation of smooth brow-tip aesthetic line. Tip was refined with volume reduction, slight underprojection, and cephalic rotation. Although the changes are not radical, her nose looks more feminine.

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