Revision rhinoplasty — how often? Comparing numbers by material in research

In rhinoplasty using synthetic material to raise the nasal bridge, revision surgery to replace or remove the implant occurs in approximately 6.40%, according to a meta-analysis of multiple studies[1]. When materials are divided into silicone, ePTFE, and porous polyethylene, the range is 6.61% to 7.64%, with no significant difference[1]. As much as material selection, it is practical to decide in advance how to reverse it if something does not fit well.

What is the revision rate?

The aggregated figure is 6.40%. In a meta-analysis of complications from rhinoplasty using high-molecular synthetic material on the nasal bridge, the pooled revision rate is reported as 6.40% (95% confidence interval 3.84–9.57%)[1].

The width of the confidence interval indicates variability in the numbers across studies. Studies with longer follow-up periods are more likely to capture replacements that occur later. When asking "what percentage," also ask how many years of follow-up the number represents.

Does the number change with a different material?

Not as much as expected. In the material-specific breakdown from the same meta-analysis, porous polyethylene was 6.61%, ePTFE was 7.06%, and silicone was 7.64%[1]. There is a ranking, but the difference is just over 1%[1].

so choosing a material based on "this one is safer" has weak evidence. It is closer to reality to think that different materials tend to have different types of complications.

What happens with silicone?

There are reports with long follow-up. In a record of 1019 cases performed over 30 years by one surgeon, the breakdown of revisions included 9 cases of extrusion (less than 1%), 4 cases of infection (less than 0.4%), and 37 cases of displacement (4%)[2].

However, this is a retrospective record from a single surgeon, and the author states it may not apply directly to other facilities[2]. On the other hand, in a study collecting people who underwent removal, the frequency of complications ranges from 4% to 36% depending on the report, and among those who underwent explantation, capsular contracture (hardening and shrinkage of the membrane around the implant) accounted for 34.8% and displacement 30.1%[3]. Note that the meaning changes depending on whether the denominator is "everyone who had surgery" or "people who had it removed"[3].

Is it safer if it is my own cartilage?

There are numbers for that too. In a meta-analysis of 53 studies, the complication rate in the group using autologous rib cartilage was 14% overall, higher than other materials[4]. This group is frequently used in revision surgery, and the impact of more difficult cases being concentrated in it is also cited as an explanation[4].

In the same meta-analysis, porous polyethylene is noted to have fewer complications, but becomes very difficult to revise in the future[4]. Based on this, the conclusion of the meta-analysis is to recommend autologous rib cartilage as the first choice for both primary and revision surgery[4].

What if replacement becomes necessary?

There is a path to revision. A method of reconstructing the nasal bridge using the capsule formed around silicone has been reported and is used to address deformities such as shortening of the nose due to capsular contracture and prominence of contours[5]. The current options for allograft and synthetic materials are also summarized[6].

If you ask in the initial consultation "what will happen if it is removed," decision-making becomes easier. Can the implant be removed, and what will replace it after removal? If the facility can answer these two questions, they can also change course along the way.

Four things to confirm at consultation

First is which material will be used and to what height, and the reason[1]. Second is the frequency of replacement or removal at that facility and the follow-up period[2]. Third is how capsular contracture or displacement will be managed if it occurs[3][5]. Fourth is whether you can choose the option of using your own cartilage[4].

The material that can be used on the nasal bridge depends on skin thickness, surgical history, and the height needed. Numbers are averages for a population and do not predict what will happen to you. At consultation, have your skin thickness and nasal bridge condition examined, and ask for an explanation comparing the advantages and reversibility of each material.