Avoid regret with rhinoplasty: How to prevent Implant (prosthesis) displacement and raising the nose too high

Regret after rhinoplasty often stems from displacement of the Implant (prosthesis) (the silicone core inserted into the nose) and dissatisfaction with the result. Infection and exposure through the skin are rare, but when they occur, removal may be necessary; a connection with raising the nose excessively has been noted. On noses that have undergone multiple surgeries, avoiding Implant (prosthesis) placement is sometimes recommended.

What are common reasons for regret?

The most common is displacement of position. In a record of 1019 cases performed by one surgeon over approximately 30 years, the most frequent complication was Implant (prosthesis) displacement, occurring in 37 patients (4%)[1]. The most common reason for revision surgery was dissatisfaction with appearance (43 patients, 4%)[1].

Displacement may be apparent immediately after surgery, or may become noticeable as swelling subsides[1]. Textbooks note that nose surgery more readily produces patient dissatisfaction than other cosmetic procedures, contributing to the higher rate of revision surgeries[2].

How often do infection and exposure occur?

Rarely. In the same record of 1019 cases, infection occurred in 4 patients, all requiring Implant (prosthesis) removal, and exposure through the skin occurred in fewer than 1% (9 patients)[1]. Most exposure cases occurred in second or later surgeries[1].

Complications occurring one month or later after surgery accounted for 5% overall (50 patients)[1]. While infection typically appears early, it can also develop later, and in such cases it is easy to miss, according to reports[1].

Why is raising the nose too high something to avoid?

Exposure and infection are noted to correlate with excessive raising of the nose height[1]. The ideal height and the height that your nose skin can accommodate without strain may not be the same.

The author of this report states that complications can be reduced through techniques such as creating precise gaps beneath the periosteum (the membrane covering the bone surface)[1]. However, the author notes this is a single surgeon's retrospective study, and findings may not apply uniformly to other surgeons[1].

What changes can occur over time?

Capsular contracture can occur—shrinkage of the membrane that forms around the Implant (prosthesis) (hardening and shrinkage around the Implant (prosthesis))—which can make the nose appear shorter, cause the Implant (prosthesis) to bend, or make the outline appear prominent[3].

Although silicone is a material that integrates well with the body and remains stable, this shrinkage is known to be possible[3]. Textbooks note that in Asian nose surgery, Implant (prosthesis) placement is used frequently, and complications correspondingly increase[2].

Is revision surgery more difficult than the first operation?

It tends to be more difficult. In a nose into which silicone was inserted at first surgery, the nasal skin becomes thinner and a membrane forms around the Implant (prosthesis)[3].

In a study of 95 patients who underwent revision surgery, 88 patients (92.6%) achieved satisfactory results[3]. On the other hand, in noses that have failed Implant (prosthesis) surgery multiple times, the Implant (prosthesis) approach should be avoided[1]. This is why reducing regret at the first surgery is important.

What to confirm before having surgery

There are three points to guide your decision. First is how high to raise the nose and whether that height puts no strain on the skin[1]. Second is how displacement or infection will be managed if they occur[1]. Third is the details of any previous nose surgery you may have had[1][3].

Textbooks note that the outcome of nose surgery varies greatly depending on technique, materials, and the surgeon's experience[2]. Post-operative management such as taping is also said to affect satisfaction[4], so confirm with your surgeon during consultation the height appropriate for your nose, including follow-up visits after surgery.