A. To put it simply: yes — the nose can be fully restored after silicone explantation using autologous tissue reconstruction, often achieving a more natural result than the original implant.

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Here's why.

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1. What happens after removal. When a silicone dorsal implant is explanted, the space it occupied collapses, leading to dorsal depression, contour irregularities, and potential skin redundancy. Additionally, some normal periprosthetic tissue is inevitably excised along with the capsule, so the post-removal nose may appear lower or more irregular than the pre-implant state.

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2. Autologous reconstruction options. Septal cartilage, conchal cartilage, costal cartilage, dermal fat grafts, acellular dermal matrix (ADM), and temporalis fascia can all be used — individually or in combination — to rebuild dorsal height and tip structure without any alloplastic material.

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3. Simultaneous removal and reconstruction. In most cases, explantation and reconstruction can be performed in a single operative session, eliminating the need for a second surgery. However, when significant infection or severe capsule inflammation is present, a staged approach — removal first, followed by reconstruction after tissue healing — may be indicated.

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Why the Closed Approach Makes a Difference

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The closed technique allows simultaneous implant explantation and autologous reconstruction through endonasal incisions alone. After removing the implant and debriding the capsule, the same surgical corridor is used to place the autologous graft. Because there is no external incision, the skin's vascular supply is fully preserved — critically important in tissue that has already been thinned and weakened by years of implant pressure. Costal cartilage can be carved into a dorsal implant-equivalent shape and placed through the same endonasal approach.

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When to Be Cautious

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- Patients with long-standing implants may have significant skin thinning and periprosthetic calcification, requiring careful capsule management.

- Post-explantation, dermal irregularities or surface contour defects may necessitate soft tissue augmentation using dermal grafts or ADM.

- If there is a documented history of implant-related infection, it is safer to explant, allow tissue recovery, and reconstruct in a separate stage.

- The risk of vascular injury and nerve damage exists with any explantation, but is minimized in the hands of an experienced specialist.

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What I've Observed in Clinical Practice

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In my experience, the majority of patients who undergo silicone explantation with simultaneous autologous reconstruction report greater satisfaction with the natural texture and appearance compared to their prior implant result. For dorsal augmentation, I often use dermal fat grafts or temporalis fascia wrapping, combined with conchal or septal cartilage tip reinforcement. For patients with adequate native dorsal height, an implant-free reconstruction is particularly effective. When the dorsum is very low, a carved costal cartilage block graft provides sufficient projection.

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Surgeon's Note

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If you're considering silicone removal, the plan should never be "just take it out." It must include a comprehensive reconstruction strategy. As a surgeon who has performed all revision and reconstructive rhinoplasty exclusively through the closed technique, I place great importance on addressing both function and structural integrity in every procedure.

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Summary

- Post-explantation autologous reconstruction (cartilage, dermal fat, fascia) restores natural contour and texture

- The closed approach enables simultaneous removal and reconstruction with preserved skin vascularity

- Skin condition, infection history, and dorsal height must guide the individualized reconstruction plan