Prevention and Resolution of Silicone Implant-Related Problems in Secondary Rhinoplasty Using a Cross-Linked Human Acellular Dermal Matrix

Kook WS, Ryu DH, Baek W, Kook HM, Jang YY, Lew DH.

PubMed 36728206 Publisher (DOI)Free full text (PMC)

What this paper says

In 56 patients whose silicone nasal implants were removed and replaced with a processed human skin matrix, satisfaction scores rose from 31.7 before surgery to 81.4 at one year.

Overview

Silicone implants placed on the bridge are common in Asian rhinoplasty practice and often need revision because of infection, contracture, visibility or movement. The authors tested cross-linked acellular dermal matrix, a sheet of donated human skin stripped of its cells, as a biological replacement for the implant. Every patient had the old silicone, the surrounding capsule and scar tissue removed, the bridge rebuilt with the matrix, and tip work done with the patient's own cartilage.

Sections of note

Design: prospective study of 56 patients with at least one year of follow up, drawn from 104 secondary rhinoplasties performed between January 2015 and December 2018. Level of evidence therapeutic IV.
Every patient had silicone, capsule and scar removed, dorsal augmentation with the matrix, and tip plasty with the patient's own cartilage.
Outcome measure: the modified Rhinoplasty Outcome Evaluation, a 10 item questionnaire completed before surgery, at 6 months and after 1 year.
Mean scores: 31.7 before surgery, 77.3 at 6 months, 81.4 at 1 year. Mean differences 45.6 and 49.7, both p less than 0.001.
Complications: one infection and three cases of excessive resorption, with no other major complications reported.

What it means for a patient

If a silicone implant has caused problems, this series suggests replacing it with donated dermal matrix plus your own cartilage at the tip can raise satisfaction substantially.
Resorption is a real risk. Three of 56 patients had excessive shrinkage of the graft within the study.
Limits: single clinic, no comparison group using silicone or rib cartilage, 56 of 104 eligible patients analyzed, and outcome measured only by patient questionnaire.

Why this paper matters

Revision after silicone augmentation is a large share of Asian rhinoplasty practice, and every replacement carries a trade off between shape, infection risk and donor site pain. Dermal matrix avoids harvesting rib or ear cartilage. Resorption beyond one year, and comparison with diced rib cartilage, remain open.

Terms

Acellular dermal matrix: processed donated skin with all cells removed, leaving a collagen scaffold.
Capsule: the scar shell the body forms around an implant.
Contracture: tightening of scar tissue that distorts the nose.
Resorption: gradual absorption and loss of graft volume by the body.
Rhinoplasty Outcome Evaluation: a patient questionnaire scoring satisfaction with the nose.

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

Abstract

Background: Silicone implant augmentation rhinoplasty along with various tip plasties are commonly performed in Asian patients, but a revision rhinoplasty is frequently required because of various problems. Secondary rhinoplasties are often performed using silicone, dermofat, costal cartilage block, or diced rib cartilage, but often result in unsatisfactory outcomes. This study assessed the surgical outcomes and complications of cross-linked acellular dermal matrix (ADM) as an alternative biological substitute for silicone implant in secondary rhinoplasty.

Methods: The authors prospectively studied 56 patients with a minimum follow-up of 1 year among 104 patients who underwent secondary rhinoplasty in their clinic between January of 2015 and December of 2018. Silicone implant, capsule, and scar tissue removal; dorsal augmentation with ADM; and tip plasty using autogenous cartilage were performed for all of them. The results were assessed using the modified Rhinoplasty Outcome Evaluation, consisting of a 10-item questionnaire completed preoperatively, 6 months postoperatively, and over 1 year postoperatively.

Result: One infection and three cases of excessive resorption were noted, with no other major complications. The mean modified Rhinoplasty Outcome Evaluation score was 31.7 on preoperative evaluation, 77.3 at 6 months postoperatively, and 81.4 at 1 year postoperatively (mean difference, 45.6 and 49.7, respectively; P < 0.001).

Conclusions: Various problems that occur after primary rhinoplasty using silicone implants can be resolved successfully with secondary rhinoplasty by dorsal augmentation using the cross-linked human ADM along with various nasal tip work using autogenous cartilage. Surgical outcome showed favorable resolution of contracture deformities, a low infection rate, firm fixation of the implant, good skin texture/thickness of the skin/soft-tissue envelope, and gain of desired height and dorsal line.

Clinical Question/Level Of Evidence: Therapeutic, IV.

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