Silicone Implant Is Safe for Primary or Revision Rhinoplasty in the Asian Patient

Goals/Purpose: Asian rhinoplasty requires a large degree of dorsal augmentation that is difficult to achieve with autologous tissue due to risk of contour irregularities, warping, instability, donor site morbidity, and extended operating time. Silicone implants for dorsal nasal augmentation avoid the complications associated with autologous tissue but are infrequently used in North America due to reportedly high rates of complications including infection, extrusion, or implant migration. Surgeons in Asia regularly use silicone implants for rhinoplasty. This study evaluates the safety profile of silicone implants in Asian rhinoplasty patients.

Methods/Technique: Retrospective review was performed of all patients undergoing primary or revision rhinoplasty by a single surgeon in the U.S. with a silicone implant between 2019 and 2021. All patients were Asian and requested increased dorsum and tip projection with decreased cephalic tip rotation. Rhinoplasty was done with a shaped silicone implant (1.5mm to 4.5mm thick) to the nasal dorsum and autologous septal and/or conchal cartilage as a tip graft. Recorded variables included age, gender, surgical approach, length of follow-up, and complications such as infection, necrosis, malposition, and need for revision surgery.

Results/Complications: Twenty-four patients underwent rhinoplasty with a silicone implant (20 primary, 4 revision). Patients were 67% female (n=16) with average age of 57 years. An open approach was used in 83% of patients (n=20). Patient were followed for 10 months on average (range 1 to 22 months). Average operative time was 2 hours and 37 minutes. All patients were satisfied with the amount of dorsal height augmentation. No contour irregularities or step-offs were observed. No instances of infection, cellulitis, skin necrosis, or extrusion were observed. Three patients needed revision (12.5%) for the following: caudal migration of the implant at 2 months (n=1), nasal tip over-projection (n=1), and hypertrophic scaring at the columellar incision (n=1).

Conclusion: Dorsal nasal augmentation with a shaped silicone implant is safe, effective and time-efficient in both male and female rhinoplasty patients. Implant migration was an infrequent complication. Silicone implants should be considered for augmentation rhinoplasty in select patients who desire significant dorsal augmentation and limited donor site morbidity. Older patients who desire decreased operative and healing time are also good candidates for silicone implant.