This case report describes the use of a silicone implant for augmentation rhinoplasty in a 17.5-year-old male patient with a saddle nose deformity caused by a childhood nasal infection. A silicone implant was placed through an incision in the columella to reconstruct the nasal dorsum. The postoperative result showed good correction of the nasal deformity with no complications. The report discusses the advantages of silicone implants for augmentation rhinoplasty, including affordability, reduced risk of extrusion or infection compared to other implant materials, and the ability to provide adequate support and definition to correct mild to moderate nasal deformities.

1. July 2013. Vol. 2, No.3 ISSN 2307-2083
International Journal of Research In Medical and Health Sciences
© 2012-2013 IJRMHS & K.A.J. All rights reserved
http://www.ijsk.org/ijrmhs.html
10
CASE REPORT: SILICONE IMPLANT IN AUGMENTATON OF
SADDLE NOSE
Dr. Smrity Rupa Borah Dutta (Assistant Professor), Dr. Sachender Pal Singh (PGT), Dr.
Aakanksha Rathor (PGt),
Otorhinolaryngology Department, SMCH, Silchar
ABSTRACT:
The term 'saddle nose' means abnormally concave nasal dorsum. Augmentation Rhinoplasty remains an
area of challenge and controversies especially for the selection of implant material. A number of materials,
both natural and synthetic, have been used for this. Although autografts are associated with lower infection
rates, they are also associated with long-term resorption and donor-site morbidity. This is a case report on
silicone implant in augmentation rhinoplasty highlighting the advantage of being affordable, no second
surgical site, less chance of extrusion if placed with appropriate techniques, to the patient requiring mild to
moderate increase in height, with good outcome.
KEYWORDS: Saddle nose, augmentation rhinoplasty, silicone implant
1. INTRODUCTION:
Almost every individual desires to have an
aesthetically placed nose. But due to various
unavoidable circumstances – like infections, birth
defects, trauma, post operative etc, the normal
architecture of the nose may be altered leading to
sometimes an unsightly facial appearance.
Many different implant materials can be used
for reconstruction. Each implant has its own
merits and demerits. Goal of nasal reconstruction
is to create an aesthetically inconspicuous nose
while preserving nasal function. Silicone is the
first polymeric alloplast which was used widely in
facial plastic surgery. A case of silicone nasal
implant is presented below.
2. CASE REPORT:
Anwar Hussain Mazumdar, 17 ½ years of age,
muslim male, hailing from Gangpardhumkar Part
–III, Dist Hailakandi, Assam presented himself in
Otorhinolaryngology department of Silchar
Medical College & Hospital in the month of May
2010 with saddle nose deformity. He gave history
of some nasal infection while he was about 4-5
months of age, following which the saddle
deformity occurred. Besides cosmetic deformity,
the patient also complained of nasal obstruction
which was more during the attacks of cold.
On examination it was seen that his dorsum of
the nose was depressed with a bulbous tip (figure
1) and narrow nasal cavities.
Figure 1. Preoperative photo
The Silicone implant was placed in place after
making vertical skin incision at the columella and
appropriate dorsal tunnel, under general
anaesthesia (figure 2).

2. July 2013. Vol. 2, No.3 ISSN 2307-2083
International Journal of Research In Medical and Health Sciences
© 2012-2013 IJRMHS & K.A.J. All rights reserved
http://www.ijsk.org/ijrmhs.html
11
Figure 2. Intra operative photos
Splint and stitches were removed after six days
.There were no complications in the post
operative period and the follow up is uneventful
(figure 3).
Figure 3. Post operative photos
3. DISCUSSION:
3.1 Nasal implants are used in various cases
a) To correct nasal deficiencies in the dorsal area,
tip and the sides
b) To give height to a flat nose or tip
c) To support a drooping nasal tip.
d) In revision rhinoplasty where too much
cartilage was removed.
3.2 A nasal implant is either a
a) Biological material
 Autograft – (patient’s own tissue)-
septal cartilage, conchal cartilage, rib,
iliac crest.
 Homograft/Allograft – (tissues from
same species)-processed through
FDA approved methods (rib bank).
 Xenograft – (tissues from different
species)-porcine or bovine collagen.
b) Synthetic biocompatible material –
Silicone, Medpore, Gortex, expanded
Poly Tetra Floro Ethylene (ePTFE),
Hydroxyapatite.
3.3 Ideal material for augmentation should
have the following criterias:
 Tolerance for the material by the host
 Should be malleable & nonresorbable
 Physical properties should match the host
tissue to look and feel 'natural'
 Easy to handle
 Should be stable i.e. not migrate from the
implantation site
 Noncarcinogenic, nontoxic and
nonimmunogenic
 Be easily available & in adequate amounts
 Nondestructive to local tissues and so will
not interfere with healing;
 Easy to sterilize
 Easy to remove if necessary
 Cost-effective
3.4 Fate / Disadvantages of natural grafts:
>. Absorb with time
> . Deteriorate with time
> . Sometimes warp (twist) over time
(rib cartilage has higher risk of warping)
> . Sometimes one’s own cartilage is too
soft & weak to give the needed
definition
> . In severe saddle or traumatic noses,
cartilage may not give the needed height
>. In people with thick skin, cartilage may
be thin & weak to support the thick skin
> . While obtaining rib cartilage, there may
be pneumothorax
>. With iliac crest, shape may not be
appropriate
>. Second surgical site scar in donor area
with potential for infection & poor
scarring.
BUT synthetic implants have certain
advantages & are used and have been tested not
just for cosmetic or reconstructive purposes in the
nose but are used for reconstructive purposes in
other parts of the face, body and joints with a long
record of follow up.
Of the various synthetic implants available,
silicone implant is most preferred which is made
of medical grade solid silicone and is non porous.
It is solid yet flexible.
3.5 Silicone nasal implant:

3. July 2013. Vol. 2, No.3 ISSN 2307-2083
International Journal of Research In Medical and Health Sciences
© 2012-2013 IJRMHS & K.A.J. All rights reserved
http://www.ijsk.org/ijrmhs.html
12
. Avoids donor site morbidity
. Resistant to resorption
. Low extrusion rate (almost nil, unlike
medpore)
. Low infection rate
. Easily available and comes in different
sizes & shapes.
. Easy to handle and shape (pre & intra
operative)
. Is an inert material (unlike Teflon &
Proplast)
. Do not warp (twist)
. Have adequate strength to provide support
. Gives superior definition to dorsum & tip
. Can be easily removed if needed in future
(unlike Gortex & Medpore)
In Asian patients it is a very successful implant
material because of relatively thick skin-soft
tissue over the implant.
Results are very good with silicon in primary
rhinoplasty then secondary rhinoplasty. Larger
size of implant has greater rate of extrusion &
infection.
No immunological reaction has been reported
till now with silicone implants. It has been
universally accepted in breast augmentation and
has been used successfully as a nasal implant for
more than 30 years.
So SILICONE implant is nearly the ideal
implant material.
3.6 Infection and Extrusion / Rejection risks can
be minimized by:
1. Using implants on healthy, non smoking
patients with thick skin
2. The dissection of the pocket for the implant
must be precise.
3. Edges of the tunnel should be tapered,
creating smooth round corners.
4. Placement should be as deep as possible and
not in the subcutaneous tissues
5. By avoiding excessive manipulation from
outside.
Enough progress has been made in the
understanding of implant physiology to find the
ideal nasal implant, i.e. Silicone.
4. REFERENCES:
1. Constantino PD. Synthetic biomaterials for soft-
tissue augmentation and replacement in the head
and neck. Otolaryngologic Clinics of North
America. 1994; 27: 223-62.
2. Silicone in nasal augmentation rhinoplasty: A
decade of clinical experience; Plastic
Reconstructive Surgery, 1998.
3. Grafts and implants in rhinoplasty & nasal
reconstruction; Otolaryngical Clinics Of North
America, 1999.
4. R. Mc Curdy J A – The Asian Nose:
Augmentation Rhinoplasty with silicone implants;
Facial Plastic Surgery. 2002.
5. Erlich MA Parhiesea – A nasal Reconstruction –
State of the art; Current opinion in Otolaryngology
Head & neck Surgery, 2004.
6. Yang J, Wang X, Zeng Y, Wu W: Biomechanics
in augmentation rhinoplasty. J Med Eng Technol
29:14-17, 2005
7. Tham C, Lai Y, Weng C, Chen Y: Silicone
augmentation rhinoplasty in an oriental
population. Ann Plast Surg 54:1-5, 2005.
8. Araco A, Gravante G, Araco F, et al: Autologous
cartilage graft hinoplasties. Aesthetic Plast Surg
30:169-174, 2006 Rhinoplasty- Nose Lift page3,
2007.
9. Guy Lin, MD, William Lawson, DDS, MD,
Complications using grafts and implants in
rhinoplasty ;Operative Techniques in
Otolaryngology (2007) 18, 315-323