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Rhinoplasty - Silicone Vs Cartilage

Rhinoplasty - Silicone Vs Cartilage

Rhinoplasty is one of the most common plastic surgeries performed and rightly so. There is a wide variety of reasons you might have for looking into this and they range from difficulty breathing, improving self-confidence or simply to change the appearance of your nose. Whatever the reason may be, we want to help you understand the difference between a silicone implant and an autologous (cartilage) rhinoplasty before your official consultation with a plastic surgeon. 

Before we explore the differences between these two procedures, we want to share that Rhinoplasty is not just about implants and adding something to your nose. It can also involve reshaping as well as removal. Here are some common reasons where this can happen in Rhinoplasty.

Top Reasons for Rhinoplasty

Hump Nose

Hump Nose

Having a hump nose is completely normal but if you have had one all your life and would like to get it addressed, the procedure during rhinoplasty would involve smoothing out the cartilage on the bridge of the nose. 

Crooked Nose or Deviated Septum

Crooked Nose or Deviated Septum

When fixing a crooked nose, the procedure can allow for a symmetrical appearance as well as to repair a deviated septum through septorhinoplasty.

Under or Overly Projected Nose

Under or Overly Projected Nose

Overly projected or overly wide nose bridges can cause noses to look too large for the size of a face while an under projected nose can cause noses to, conversely, look too small for a face. This can also be addressed through a reduction or augmentation rhinoplasty, respectively.

Bulbous or Misshapen Nose Tip

Different types of nasal tips

A bulbous or misshapen nose tip can really affect the appearance of someone’s face. This is one of the toughest things to address about the nose as it involves multiple tissue types - the nose tip skin, the fatty layer below, as well as the cartilages of the tip (lower lateral cartilages). Procedures to reshape the tip often entail the reshaping of the tip cartilages as well as the addition of cartilage grafts. The fatty tissue of the tip may also need to be carefully trimmed, as over removal can cause the skin of the nose tip to turn black (necrosis).

Large Nostrils

Large Nostrils

Lastly, even overly large nostrils can be reduced during surgery if you should wish it so. This is performed with a simple alar reduction that involves the removal of a crescent-shaped piece of tissue at the base of the nostrils.

Silicone Implants

Silicone implants are a reliable type of implant that has been used for many years and improved upon multiple times. The silicone implants we see today can be shaped precisely into what is needed for each individual patient. This allows for customisation towards your face and to suit your own particular needs. In addition to these anatomical implants, soft silicone implants are used in lieu of the hard stiff silicone that traditional implants were carved from, resulting in a much more natural appearance and feel. Having multiple honest consultations with a plastic surgeon will help them to precisely carve out what is needed for you during this journey. 

These implants come in two common shapes: L-shape and I-shape. However, at Allure, we use only the I-shape implant as the L-shape implant has a much higher rate of extrusion. The L component of the implant is replaced with cartilage grafts to create the tip projection and definition, resulting in a much more natural appearance with a reduction in implant extrusion rates.

Silicone implants are popular because they can be easily removed or replaced in the case of malposition, infection or protrusion. 

Pros of Silicone Implants:

  • They can be shaped to each individual’s wants and needs, getting very precise to what each patient requires
  • Has been tried and tested multiple times over the years so there is a lot of research that has been done on the implants, allowing for better response in case there should be complications
  • Easy removal and replacement 

Cons of Silicone Implants:

  • Migration after placement because of the lack of integration with underlying structures of the nose
  • They feel hard and unnatural beneath the skin, especially if non-soft silicone implants are used.
  • Prone to infection which may lead to further damage to nasal appearances

However, every type of material has its pros and cons. With the right amount of check-ups, some things can be avoided after a successful surgery. 

Gore-tex implants were very popular at one stage, due to the high rate of tissue integration, which meant that they were less likely to migrate or get displaced. However, many surgeons realised that because of this extensive tissue integration, it was extremely difficult to revise a Gore-tex implant rhinoplasty if there were problems, often needing to remove a huge amount of nasal tissue around the implant in an en-bloc fashion, resulting in a long recovery time and poorer outcomes.

Autologous (Cartilage) Rhinoplasty

Autologous (Cartilage) rhinoplasty is created from a patient’s own body and is considered one of the top choices during Rhinoplasty. Far from being a dangerous practice, it is almost always necessary to harvest some amount of cartilage during surgery. Due to rumours and misinformation spread on the internet, cartilage rhinoplasty has been seen as an unattractive procedure for a long time but during proper consultations, plastic surgeons will always tell you that the misinformation you have heard is not accurate. 

Through manipulation of existing nasal cartilage as well as the use of the nasal septal cartilage, autologous rhinoplasty can address multiple issues such as an under projected tip, a short nose, droopy nasal tips and so on. However, if there isn’t enough nasal cartilage tissue in a patient’s nose, surgeons will then use cartilage grafts from other areas to rebuild the nose.

Some areas in the body that exist as donor sites for external cartilage are the ear (conchal) or the rib (costal). But if these areas are not available during surgery for grafting, or if the patient elects to not use these sites, donated sterilised cadaveric rib cartilage can also be purchased and used as a source for cartilage grafts.

Pros of Cartilage Rhinoplasty:

  • Reduction of risks of infection because the cartilage has been harvested from the patient’s own tissue
  • Reduces the chance of extrusion as compared with alloplastic implants 
  • Can be used to rebuild nasal tips where it has already been damaged or removed 
  • A more natural, softer appearance as compared to implant rhinoplasty.

Cons of Cartilage Rhinoplasty:

  • The grafts may become visible under the skin
  • The grafts can shift
  • The grafts can dissolve
  • Donor site scarring from grafting 
  • Warping when the cartilage is placed on the nose with marked indentations, asymmetries or crooked sections of the nose. However, the risks are reduced if the surgery has been done expertly. 

However, with these pros and cons laid out for both types of implants, it is important for us to clarify that many of these “cons” can be avoided if the plastic surgeon is experienced and carries out a surgery well. Something that you should always look into when exploring different clinics and surgeons is each surgeon’s track record.

In addition to cartilage, dermofat grafts are also used to augment the shape of the bridge, though less commonly. These grafts are harvested from the midline cleft between the buttock cheeks, resulting in a well-hidden scar and minimal donor issues. This dermofat graft is then trimmed into an implant-like shape before being inserted into the nose just like a silicone or cartilage implant. The advantage of using this graft is a much softer and very natural appearance of the bridge after the surgery. The disadvantage is a longer period of swelling as the graft slowly integrates as well as it does not allow for very high augmentations of the bridge.

The nose is a prominent part of our face and identity. When choosing a plastic surgeon, we highly recommend you to consult with as many as you can and to take into account the surgeon’s knowledge of the different types of noses that each ethnicity can have. The way all our noses are built is very different and these differences can be even wider between the different races. 

When consulting with various plastic surgeons, always make sure that the conversation is open and honest during your journey. Not just because it is essential to know who will be operating on you but to also know the practices of the clinic, track records as well as exploring what you are trying to get out of the surgery. It is important to be as precise and open as possible with what you’re hoping to get rid of or to modify, what issues you currently have whether it is cosmetic or health-related as well as what you’re comfortable with. It is a journey that you will be embarking on and it is important that you feel safe during the process. 

Lastly, do your own preparations before a consultation by gathering your medical history and to write down some questions you might have for your doctor. During your meeting, you will be asked to go for a physical examination, go through your medical history as well as have your nose photographed such that your surgeon can manipulate the photos to show you what kind of results are possible. We hope that this article helps you prepare for a rhinoplasty consultation with your doctor.