Effective Use of a Silicone-induced Capsular Flap in Secondary Asian Rhinoplasty

Jeong JY, Oh SH, Suh MK, Kim CK, Kim KK.

PubMed 25289365 Publisher (DOI)Free full text (PMC)

What this paper says

In 95 Korean patients having a second nose operation after a silicone implant, keeping the scar capsule as a flap rather than removing it gave satisfactory results in 92.6 percent over a mean 31.7 months.

Overview

The body forms a scar capsule around a silicone implant. That capsule can tighten and shorten the nose, or let the implant shift or show. Removing it is difficult because the overlying skin is already thin. The authors instead used the capsule itself as a living layer during revision surgery.

Sections of note

Case series of 95 Korean patients, 91 women and 4 men, mean age 27 years, all with previous silicone augmentation.
Technique: a dual plane was created above the anterior capsule and below the posterior capsule to form the flap; the old implant was removed and a new silicone implant placed under the posterior capsule. Tip plasty was also performed.
Follow-up ran from 6 months to 4 years, mean 31.7 months.
Satisfactory results were reported in 88 of 95 patients (92.6 percent).
No hematoma and no compromise of the nasal skin blood supply occurred.
No visible or palpable capsule resorption and no recurrent capsular contracture were observed.
Early implant malposition within 30 days occurred in 4 patients, and tip shape dissatisfaction within 60 days in 3; 4 patients had further surgery with successful outcomes.

What it means for a patient

The scar capsule around an old implant can be used as tissue rather than discarded, which avoids stripping already thin skin.
Most problems appeared within the first two months, and revision resolved them.
This was a single practice series with no comparison group, so it does not show the flap is better than capsule removal.
A new silicone implant was still placed, so the long term risks of silicone remain.

Why this paper matters

Revision after implant based augmentation is common in this population, and the thinned skin is the limiting factor. Whether the capsular flap protects the skin over five or ten years is unanswered.

Terms

Capsule: the layer of scar tissue the body forms around an implant.
Capsular contracture: tightening of that scar layer, which can distort or shorten the nose.
Capsular flap: using the capsule as a living tissue layer rather than removing it.
Dual plane: dissecting in two separate tissue levels to raise a layer between them.
Resorption: gradual absorption and loss of tissue by the body.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Performing secondary rhinoplasty in patients who underwent primary rhinoplasty using a silicone implant is difficult due to thinning of nasal skin and formation of a capsule. Excess capsule formation can cause capsular contracture, resulting in short nose deformity or implant deviation, migration, or implant demarcation. Revision rhinoplasty using a capsular flap, dorsal silicone implant, and tip plasty was performed in 95 Korean patients (91 women and 4 men; mean age, 27 years) who previously underwent primary augmentation rhinoplasty using silicone implants. The capsular flap was composed by creating a dual plane above the anterior capsule and below the posterior capsule. The existing silicone implant was removed, and a new silicone implant was placed under the posterior capsule. The patients were followed up for 6 months to 4 years (mean, 31.7 months). Of the 95 patients who underwent secondary augmentation rhinoplasty using a capsular flap, 88 patients (92.6%) showed satisfactory results. There was no hematoma or nasal skin vascular compromise. There was no visible or palpable capsule resorption or recurrent capsular contracture. Early implant malpositioning (within 30 days postoperatively) was observed in 4 patients, and tip shape dissatisfaction (within 60 days postoperatively) was reported by 3 patients. Four patients underwent revision surgery and had successful outcomes. Nasal augmentation using a silicone implant and capsular flap in secondary rhinoplasty avoids complications caused by removal of the capsule. Recurrent capsule formation or clinically noticeable resorption of the capsular flap was not observed in this study.

Abstract as indexed by PubMed; the article is open access (PubMed Central).