Gross and pathologic analysis of long-term silicone implants inserted into the human body for augmentation rhinoplasty: 221 revision cases.
BACKGROUND
In augmentation rhinoplasty, delayed morphologic changes are often observed with silicone implants, despite them being known as a safe implant material. The purpose of this study was to identify the cause and time course of delayed shape changes of silicone implants, through the long-term evaluation of inserted implants and their surrounding nasal soft tissues after their removal at revision rhinoplasty operations.


METHODS
Two hundred twenty-one silicone implants removed during revision rhinoplasty were studied. The period of insertion ranged from 1 month to 25 years, with an average of 6 years 7 months. Calcification within the silicone implants and, when available, the capsular soft-tissue attachments were examined with the naked eye and light microscopy.


RESULTS
Calcification was first observed grossly with the naked eye after 5 years 8 months of insertion. With light microscopy, calcification debris could be seen after 4 years. After implant insertion for more than 9 years, focal calcification could be seen in 50 percent of implants. When implants had been inserted for more than 15 years, a denatured type of large calcification was clearly observed. Plasma cell, macrophage, and neutrophil proliferation was noted in the soft-tissue capsule surrounding the superficial calcifications in those individuals with an early inflammatory response, and lymphocyte proliferation was noted in those with a late inflammatory response.


CONCLUSIONS
Silicone implants were noted to induce calcification when inserted for a long time, causing long-term morphologic changes. This should be taken into consideration when choosing silicone implants for augmentation rhinoplasty.
Jung
Dong Hak
DH
Seoul, South Korea; and Orlando, Fla. From the Simmian Aesthetic Clinic and Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology, Kangdong Sacred Heart Hospital, Hallym University School of Medicine, and Florida Ear, Nose, and Throat and Facial Plastic Surgery.
Kim
Bum Ryul
BR
Choi
Ji Yoon
JY
Rho
Young Soo
YS
Park
Hyo Jin
HJ
Han
Wade W
WW
D000328:Adult; D002114:Calcinosis / Q000209:etiology / Q000601:surgery; D020878:Device Removal; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D005549:Foreign-Body Reaction / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D019736:Prostheses and Implants / Q000009:adverse effects*; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000295:instrumentation*; D012826:Silicone Elastomers / Q000009:adverse effects*; D000267:Tissue Adhesions / Q000209:etiology / Q000601:surgery
D012826:Silicone Elastomers