Alloplastic implants

What repeats

Five findings that hold across the literature.

The complications are the same list in every review

Reviews of implant rhinoplasty name infection, extrusion, movement, irregularity, absorption, prolonged swelling, seroma and contracture. A second review lists displacement, deviation, a suboptimal aesthetic outcome, extrusion, inflammation, infection and changes in skin quality as the complications that need a further operation. Extrusion and infection are the two named as most feared in the revision literature.

Rests on: Choi, complications of alloplast rhinoplasty · Jang et al., failure of synthetic implants · Fung and Jang, revising the extruding or infected implant.

Infection in a rhinoplasty practice tracked the implant

A retrospective review of 662 rhinoplasty procedures by three faculty surgeons between 1999 and 2008 recorded postoperative infection in 2.8%, which is 19 of the 662. In every case of infection, alloplastic material had been used. Infection occurred in one in five procedures in which porous high-density polyethylene was used. Where expanded polytetrafluoroethylene was used alone the infection rate was 5.3%. Exposure developed in 12% of the patients who received an alloplast.

Rests on: Winkler et al., complications associated with alloplastic implants.

Large single-surgeon series report low complication numbers

A retrospective review of 1054 Southeast Asian patients given expanded polytetrafluoroethylene reported 1030 desirable outcomes and 24 undesirable ones. Implant deviation was the commonest undesirable outcome at 1.04%, followed by a visible implant at 0.47%, with implant infection in 0.38%. A Korean series of 873 patients used hard-type Gore-Tex between 1998 and 2007, and a thirty-year single-surgeon series covers 1019 implant rhinoplasties performed between 1995 and 2024. A general review of rhinoplasty risk puts the complication rate for silicone implants between 5 and 20%, and reports fewer complications with other materials such as Gore-Tex.

Rests on: Yap et al., expanded polytetrafluoroethylene · Hong et al., Gore-Tex implants · Kwan et al., thirty-year experience · Rettinger, risks and complications.

Failures arrive years after the operation

An implant can fail long after the wound has healed. A 53-year-old woman presented with palpable and visible stepping of the dorsum about a year after it appeared, and computed tomography showed her L-shaped silicone implant had fractured, with no history of nasal trauma since surgery. A porous polyethylene implant has been reported migrating from the nose to the forehead, where it presented as a cutaneous fistula.

Rests on: Lee and Min, spontaneous fracture of a silicone implant · Alonso et al., cutaneous fistula of the forehead.

The implant is a common reason for a second operation

In a three-year Korean practice, 52 of 623 rhinoplasties were revisions. Of those 52, 33 were related to a problem with an alloplastic implant, the commonest being deviation of the implant, followed by extrusion.

Rests on: Won and Jin, revision rhinoplasty in Asians · and revision rhinoplasty.

By material

Three polymers are in routine nasal use, and they fail differently.

Silicone

Silicone is the most widely used material for nasal augmentation in Asian countries, on grounds of handling, volume and the fact that it can be removed as a whole piece. The review that makes that point also states that reported complication rates vary widely with surgeon experience, surgical technique and implant design, and that silicone can be used safely if precautions are taken.

Rests on: Kim, augmentation rhinoplasty using silicone implants · Kwan et al..

Expanded polytetrafluoroethylene

Tissue grows into expanded polytetrafluoroethylene, so it moves less and is harder to remove cleanly. The 1054-patient series reported it as a synthetic material with proven outcomes for dorsal augmentation. The 662-procedure academic review reported a 5.3% infection rate where it was used alone.

Rests on: Yap et al. · Winkler et al..

Porous high-density polyethylene

The most integrated of the three, and the hardest to take out. A series of 23 patients treated for adverse reactions reported that removal is complex because connective tissue forms inside the implant, that most presented with extrusion at the columella, and that the complications can leave permanent atrophic change in the nasal skin. In the 662-procedure review, one in five procedures using this material became infected. A separate series used a single full-length porous polyethylene implant to span the bridge in 37 patients drawn from a consecutive series of 1273 rhinoplasties.

Rests on: Machado et al., extrusion of porous polyethylene implants · Winkler et al. · Thornton and Mendelsohn, total skeletal reconstruction.

What replaces an implant that fails

After removal, the materials named for rebuilding the dorsum are dermofat, acellular dermis, fascia-wrapped diced cartilage, conchal cartilage with its perichondrium, and costal cartilage. One protocol reconstructed 18 noses with extruded implants immediately, using irradiated homograft costal cartilage, with at least a year of follow-up. A later series took the same immediate approach with autologous cartilage in eight patients with infected implants, on the stated grounds that scarring and soft tissue contracture make delayed reconstruction harder.

Rests on: Jang et al. · Clark and Cook, immediate reconstruction · Calvert et al., infected nasal alloplast · and rib cartilage grafts.

What to ask about an implant

Questions the evidence supports asking.

Which material are you using, and why that one

The three polymers differ in how far tissue grows into them, which sets both how well they stay put and how hard they are to remove. Ask the surgeon which one they use, and what they do when one has to come out.

Rests on: Choi · Machado et al..

What is your own infection and extrusion rate

Published rates run from under 1% in large single-surgeon series to one in five for one material in one academic practice. The spread is the reason to ask for the surgeon's own number rather than a number from the literature.

Rests on: Yap et al. · Winkler et al. · Kim.

What happens in ten years

The failure reports are delayed: a fractured implant found a year after symptoms began, an implant that migrated to the forehead. Ask what the follow-up plan is and what would prompt a scan.

Rests on: Lee and Min · Alonso et al..

What is the plan if it has to come out

The reconstruction after a failed implant is a bigger operation than the original, using the patient's own cartilage or a homograft. Ask whether removal and rebuilding would be done in one stage or two.

Rests on: Clark and Cook · Calvert et al. · and saddle nose.

Would my own cartilage do the job instead

Autologous cartilage avoids infection and extrusion and brings its own problems, which the risk review names as dislocation and resorption, and a donor site. Ask what the surgeon would need to harvest to reach the same height.

Rests on: Rettinger · Khatlah et al., autologous versus alloplastic grafts · and rib cartilage grafts.

The terms, defined

The words used about these implants.

• Alloplastic implant: an implant made from manufactured material rather than from the patient's own tissue. [33368076]
• Autologous graft: tissue taken from the patient, most often septal, conchal or costal cartilage. [42499483]
• Silicone: a smooth polymer implant that the body walls off in a capsule rather than growing into. [30005785]
• Expanded polytetrafluoroethylene: a porous polymer, sold as Gore-Tex, that tissue grows into partially. [21768557]
• Porous high-density polyethylene: a rigid porous polymer that tissue grows into fully, which makes removal difficult. [39504408]
• Extrusion: the implant working its way out through the skin or the lining of the nose. [42091323]
• Exposure: the implant becoming uncovered before it fully extrudes. [22928175]
• Capsular contracture: tightening of the scar shell around an implant, which can shorten and deform the nose. [33368076]
• Seroma: a collection of fluid around the implant. [33368076]
• Irradiated homograft costal cartilage: donor rib cartilage sterilised by irradiation, used to rebuild a dorsum after an implant is removed. [12160293]

Where else this is documented

Sources outside the journals, each one free to read.

The national guideline

The American Academy of Otolaryngology publishes a clinical practice guideline on nasal form and function after rhinoplasty, with a plain language summary written for patients. It sets what the surgeon should assess and record before operating, and it applies whatever technique is chosen.

Rests on: the clinical practice guideline · the plain language summary.

The device regulator

A nasal implant is a regulated device in the United States. The Food and Drug Administration lists it under product code FZE, prosthesis, nose, internal, a class II implant. The regulation behind that code, 21 CFR 878.3680, defines a nose prosthesis as a solid silicone rubber device implanted to augment or reconstruct the nasal dorsum. Clearances are searchable by name and manufacturer in the premarket notification database, and reported failures in the device experience database.

• Product classification FZE, prosthesis, nose, internal
• 21 CFR 878.3680, nose prosthesis
• 510(k) premarket notification database
• MAUDE, the manufacturer and user facility device experience database
• Medical devices at the FDA

The surgeons' own textbook chapters

Rhinoplasty Archive, the free online rhinoplasty textbook edited by Daniel G. Becker, carries four chapters on implant augmentation, the choice of material and what happens when an implant is removed. They are written for surgeons and go further into technique than a patient page should.

• Augmentation Rhinoplasty Using Alloplastic Implants
• Saddle Nose Deformity: Selection of Augmentation Materials and Management
• Acellular Dermal Matrix in Asian tip and dorsal augmentation rhinoplasty
• Revision rhinoplasty in Asians

The reference summary

StatPearls, on the National Library of Medicine's Bookshelf, carries two chapters in full text at no charge.

• Rhinoplasty, the anatomy, the approaches and the complication list.
• Facial Implants, the materials used for facial augmentation and how they behave in tissue.

The societies

• American Society of Plastic Surgeons, patient information.
• American Academy of Facial Plastic and Reconstructive Surgery, patient information.
• The Rhinoplasty Society, the surgeons' body, with its member directory. See associations.

The trials in progress

Dorsal augmentation without an implant is under test in a registered trial.

• Mastoid Bone Autograft for Dorsal Nasal Augmentation, completed, 15 participants.

What is not settled

• A meta-analysis of complications after dorsal augmentation with synthetic materials rests on 27 observational studies, 21 retrospective and 6 prospective case series, covering 3803 cases. No randomised trial is in it. [35451637]
• A 2026 systematic review of autologous against alloplastic grafts covers studies published from 2000 to 2024 and had to assess them with tools for non-randomised evidence, because that is what exists. [42499483]
• Reported infection and extrusion rates differ by more than an order of magnitude between large private series and academic practices, and the reviews attribute the spread to surgeon experience, technique and implant design rather than to the material alone. [22928175] [21768557] [30005785]
• Follow-up in most series is measured in months to a few years, while the case reports of fracture and migration are years out. The true long-term failure rate is unknown. [37743756] [24220434]
• Whether immediate reconstruction after removing an infected implant beats a two-stage approach is argued from an eight-patient series. [37395793]