Migrated Implant Causing Refractory Headache in Rhinoplasty

Overview

Synthetic implants are widely used for nasal augmentation, and silicone is among the most common in parts of Asia because it is inexpensive and technically straightforward to place. Its recognised drawbacks are a tendency to move after implantation and to work its way out if the area is injured or the skin thins. This report describes an unusual consequence of that movement.

Sections of note

• Case report of a single patient.
• A 58-year-old woman who had augmentation rhinoplasty 20 years earlier.
• She had suffered headache for over a year.
• Brain lesions and neurological causes were ruled out by neurologists and a family medicine physician.
• Examination showed the nasion deviated upward and the vague outline of the silicone implant visible under the skin on the bridge.
• No treatment, resolution or follow-up is described in the abstract.

What it means for a patient

• Silicone nasal implants can move over years, and the movement may not be noticed until it causes a symptom.
• A headache lasting a year was investigated extensively before the nose was identified as the source, which shows how easily the connection is missed.
• The interval here was 20 years, so implant-related problems are not confined to the period soon after surgery.
• A single case cannot establish that the implant caused the headache, only that the two were found together after other causes were excluded.

Why this paper matters

Silicone implant complications, movement, extrusion and infection, drive much of the revision workload in Asian rhinoplasty, and headache is not among the usual list. Documenting an atypical presentation helps others consider the nose when other investigations come back negative. Whether removing the implant resolved the headache is not stated in the abstract.

Terms

• Alloplastic material: a manufactured implant material rather than the patient's own tissue.
• Silicone implant: a solid synthetic implant used to build up the nasal bridge.
• Implant migration: movement of an implant from where it was placed.
• Extrusion: an implant working its way out through the skin or lining.
• Nasion: the depression at the bridge of the nose where it meets the forehead.
• Refractory: not responding to the usual treatment.