Why an L-shaped silicone implant can nearly perforate the columellar mucosa: removal and reconstruction with autologous rib cartilage

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a case of a patient who suffered severe complications from an L-shaped silicone implant. The patient visited our clinic complaining that the nose was gradually becoming shorter and upturned. Upon examination, the end of the implant was in a critical state, on the verge of puncturing through the left columellar mucosa.

The patient had previously undergone rhinoplasty with an L-shaped silicone implant at another clinic. Over time, however, the following issues developed:

• The nose gradually became shorter and upturned

• The implant exerted pressure on the tissues, progressing nearly to mucosal perforation

• The skin of the nasal tip became thin and weakened

• The natural appearance was lost, resulting in an unnatural look

Because an L-shaped silicone implant extends a rigid structure all the way into the nasal tip, it exerts continuous pressure on the tip tissues over time, which can lead to complications like these.

The patient emphasized the following goals:

• Safely remove the hazardous implant

• Naturally bring down the upturned nasal tip

• Reinforcement of thinned tip skin

• Achieve a natural nasal contour rather than an excessively high or dramatic look

• Reconstruct using safe and proven methods

In a case like this, simply removing the implant was not sufficient. A comprehensive approach was required:

1. Safe removal of the L-shaped silicone implant

• Careful removal while preventing mucosal perforation

• Inspection and assessment of the damaged tissues

2. Septal extension using autologous rib cartilage

• Safely lowering the upturned nasal tip

• Providing long-term stable structural support

• Creating a natural tip shape

3. Tip skin reinforcement using autologous dermis

• Increasing the thickness of thinned tip skin

• Preventing future risk of skin perforation

• Maintaining a natural texture

4. Functional improvement

• Restoring septal function

• Improvement of breathing function

Key improvements:

• Complete removal of the hazardous L-shaped silicone implant

• Restoration of the upturned nasal tip to a natural position

• Sturdy reinforcement of the thinned tip skin

• Achieving a natural and stable nasal contour

• Improvement in nasal breathing function as well

Using autologous rib cartilage and autologous dermis allowed us to reconstruct the nose safely, avoiding the risks of complications associated with alloplastic materials.

Although L-shaped silicone implants were widely used in the past, many plastic surgeons now advise against them. The reasons include:

Problems with L-shaped silicone implants:

• Continuous pressure from a rigid material on the nasal tip

• Progressive shortening and upturning of the nasal tip over time

• Thinning of the skin with risk of implant visibility or extrusion

• An unnatural appearance

• Potential compromise of tip blood circulation

In this case, the implant was already on the verge of puncturing the mucosa; any further delay would have made management considerably more complicated. Fortunately, we were able to intervene in a timely manner, safely remove the implant, and reconstruct the framework using autologous tissues.

Advantages of autologous rib cartilage:

• No tissue rejection because it is autologous tissue

• Provides stable structural support with sufficient volume and strength

• A long-term stable and natural result

• Minimizes the risk of infection or foreign body reactions

Importance of autologous dermis reinforcement:

• Safely reinforces thinned skin

• Prevents future complications

• Maintaining a natural texture

Patient safety is always my primary focus, striving for long-term stable and natural results. If you are experiencing concerns related to an L-shaped silicone implant or other alloplastic materials, I recommend consulting with a specialist before complications progress. This has been Medical Director Dr. Peter C. Kang. Thank you.

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