Hello, this is Dr. Cha-Young Kang, head surgeon at Nose Lab Clinic.
Today, I would like to share a successful case of reconstructive surgery for a patient who experienced silicone exposure and nasal inflammation. This patient had undergone rhinoplasty at another clinic 12 years ago using silicone and ear cartilage and recently began experiencing redness and inflammation in the nose for the past five months, leading them to seek help at our clinic.
1. Pre-Surgery Design Consultation
We conducted a thorough analysis of the patient’s pre-surgery condition:
Frontal View:
The nasal tip appeared red, with thinning skin.
The bridge of the nose was swollen.
Nostril asymmetry was evident.
The nasal tip appeared wide and bulbous.
Profile View:
The nose had a bulky appearance.
The starting point of the nasal bridge at the glabella was unusually high.
Oblique View:
The high nasal bridge was prominent.
The nose appeared generally swollen, and the nasal tip showed localized redness from inflammation.
Nostril View:
The left nostril showed signs of redness.
The nostrils were asymmetrical.
Granulation tissue was visible inside the left nostril.
Patient’s Key Symptoms and Requests:
Redness started in May, with inflammation worsening over time.
Continuous use of medication to manage symptoms.
Request to remove the silicone implant.
Occasional bleeding inside the nose.
2. Surgical Plan
Considering the patient’s condition and requests, we planned the following:
a) Removal of the existing silicone implant and capsule.
b) Complete removal of infected tissue.
c) Perform a septal extension graft using autologous rib cartilage to restore the structure.
d) Reconstruct any damaged cartilage using autologous rib cartilage.
e) Thorough irrigation with antibiotic-infused saline to ensure infection control.
3. Surgical Procedure
We conducted the surgery using a closed (endonasal) approach to avoid external scarring:
a) Identifying the Infection and Silicone Exposure:
We found that granulation tissue had formed due to the infection in the left membranous septum.
Localized bleeding was observed.
Beneath the granulation tissue, the silicone implant had become exposed.
b) Removal of the Infected Tissue and Silicone:
We completely removed all the infected granulation tissue inside the nose.
The silicone implant and its surrounding capsule were removed to eliminate the source of the inflammation.
These are photos of granulation tissue observed in the left nostril.
c) Irrigation:
The surgical site was thoroughly cleansed using antibiotic-infused saline to ensure all infection was removed.
d) Septal Extension Graft:
To prevent post-surgical contraction and deformation, we performed a septal extension graft using autologous rib cartilage
e) Alar Cartilage Reconstruction:
The damaged alar cartilage from the acute inflammation was partially reconstructed using autologous rib cartilage.
All procedures were completed using a closed approach, leaving no external scarring.
4. Before and After Photo Comparison
Frontal view before surgery (left) after surgery (right)
Frontal View:
The previously bulky appearance of the nose has been corrected, resulting in a natural look.
The wide nasal tip has been refined.
Nostril asymmetry has been significantly improved.
Side profile view before surgery (left) after surgery (right)
Profile View:
The high starting point of the nasal bridge has been lowered, creating a more natural transition.
The bulky nasal tip now appears slimmer and more refined.
The nasolabial angle has been corrected, giving a balanced look between the nose and lips.
45-degree angle view before surgery (left) after surgery (right)
Oblique View:
The previously swollen nose now has a smooth and natural straight line.
Nostrils before surgery (left) after surgery (right)
Nostril View:
Nostril asymmetry has been corrected.
The shape and proportion of the nostrils have been naturally balanced.
The granulation tissue has been removed, leaving the nostrils clean and healthy.
5. Post-Surgery Photo Collection
Photos taken immediately after surgery, frontal view, 45-angle view, and side profile.
Photo of the nostrils
6. Final Evaluation
This case is a successful example of resolving issues related to silicone exposure and inflammation caused by prolonged use of an implant. L-shaped silicone implants are prone to triggering chronic foreign body reactions, which can lead to complications such as the implant pushing through the skin, especially at the nasal tip.
When this happens, patients often experience symptoms like redness, swelling, and pain resembling an acne-like pimple on the nasal tip. If left untreated, pus discharge may occur, and the nose may start contracting (a condition called nasal contracture). This patient exhibited such classic symptoms, which required urgent intervention.
The key to the surgery was the complete removal of the silicone implant and surrounding infected tissue, followed by thorough cleansing and reconstruction using autologous rib cartilage. The septal extension graft and alar cartilage reconstruction ensured that the structural integrity of the nose was restored and minimized the risk of future nasal contracture.
Even immediately after surgery, the swelling caused by the infection had significantly reduced, and the overall shape of the nose had become more balanced and natural. We plan to continue monitoring the patient’s recovery with antibiotic therapy and regular follow-ups to ensure a complete and healthy recovery.
7. Closing Remarks
Rhinoplasty revision surgery, particularly when dealing with complications like infection, requires a highly meticulous approach. In many revision cases, we often encounter complications where L-shaped implants have caused chronic foreign body reactions, leading to exposure and extrusion through the nasal skin.
When such symptoms appear, it’s critical to consult a rhinoplasty specialist as soon as possible. The longer the delay in addressing the infection, the more severe the inflammation and contracture can become, increasing the complexity of surgery and lengthening recovery time.
The first priority in treatment is to administer antibiotic therapy and remove the implant. Following that, it is essential to use autologous tissue, such as rib cartilage, to rebuild the nose. Using autologous tissue reduces the risk of rejection and ensures a more stable and natural outcome in the long term.
If you are considering revision rhinoplasty or have concerns about your initial surgery, it is crucial to consult an experienced and specialized surgeon. At Nose Lab Clinic, we offer safe and effective surgical plans based on extensive knowledge in ENT anatomy and experience in complex rhinoplasty cases.
We are here to help you achieve a healthy and beautiful nose.
This has been Dr. Cha-Young Kang, head surgeon at Nose Lab Clinic.
Thank you.
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