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L Shaped Silicone Implants – Yea or Nay?

L Shaped Silicone Implants – Yea or Nay?

Fig 1. L shaped silicone implant
L shaped silicone implants are easy to insert, and gives a nice contoured dorsal aesthetic line that is much sought after. Think billboard models and magazine cover girls.

The L shaped silicone implant works by incorporating a few features into its design to achieve 3 goals: Dosum (bridge) augmentation and contour, Tip contour and tip support. In the diagram above, you can make out the parts I have mentioned
Sounds logical, but do you know what happens in the next few months or years after the insertion is done?

Firstly, the body reacts to this foreign material. A capsule is formed around this silicone foreign body. Over time, calcification and scarring around this capsule results in contraction of the capsule. With this contraction, it can brings the dorsal skin along with it. The result is nasal shortening. The tip gets upturned causing more nostril show. And in severe cases, this could mean creating a snout-like appearance.

Fig 2. Nasal Shortening due to dorsal contraction

The angle of the “L” shaped silicone gives a nice shape to the tip. The short limb of the “L” becomes the “support” that helps to push the shape of the silicone against the skin over the nasal tip.

This creates the 2nd problem – under enough pressure, this silicone tip can compromise the blood supply to the tip skin, causing the skin to slowly thin out and eventually give way. The implant thus eventually pokes through the skin, otherwise known as implant extrusion.

Now consider the first problem of shortening compounded with the second problem of extrusion. Even if the initial placement does not cross the critical physiologic threshold leading to extrusion, as the nose shortens over the years, pressure over the nasal tip can gradually increase leading to eventual extrusion.

Pros: Easy insertion. Dramatic profile
Cons: Unnatural looking. High risk of complications, some of which are disfiguring and difficult to correct, needs to change in 7-10 years.

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