k-couture Posted February 25, 2014 Share Posted February 25, 2014 Silicone suits asians alot better than caucasians because our skin is thicker. Back in the day surgeons use the L shape silicone which caused injection and protrusion for a number of patients because the skin where the columella does not accept the hard silicone well. Currently very few surgeons use the L shape implant and instead use the I shape implant which only sits at the bridge area. You get a much more aesthetically pleasing result with a silicone than you do with a cartilage graft because of the shape. You will never get a shape as perfect as the manufactured implant. It is also much less invasive than a cartilage graft. Cartilage should be used only if you have already suffered damage from a previous rhinoplasty and your skin is too thin to use an artificial implant for fear of protrusion. Irregularity in shape (uneveness, cartilage bumps, curved implant shape) is also common in cartilage grafts. Think about it, why would you want to undergo an invasive procedure only to be subjected to aesthetic results which are less than pleasing when all you need to do is use a silicone to get the perfect nose. Not to mention that silicone can be done through closed rhino. Which is also alot less invasive and prevents scarring. When i say scarring i mean ones that occur inside the nose and make your nostrils lopsided. This could potentially happen in open rhinoplasty. In fact it happened to me too. As in my case ive had 2 rhinos. The first time it looked incredibly good when i used silicone. But problem was i foolishly had it done in thailand and it was causing me discomfort. I learnt later through a facial CT that the thai surgeon at yanhee had used a block of raw silicone, cut the shape out and shoved it in the nose so the shape was jagged at the side. They did not bother to use a proper factory manufactured impllant. After that i got a cartilage graft. Now this completely ruined my nose. The shape was humpy, bumpy and irregular and i have skin damage at the top of my bridge from cartilage protruding and thinning the skin. Its permanently red near the top of my bridge. And all this after i went through an invasive open rhino + site harvesting for the cartilage. My initial thought before i agreed to the surgery was "its not artificial its my own implant so it MUST BE GOOD" I was completely wrong. If you weigh up the pros and cons it makes no sense to use cartilage on your first rhino because silicone has a much higher chance at an aesthetically pleasing results and is less invasive. Not to mention that should you need to remove it, silicone is very easy to remove. While cartilage is more difficult especiallty if you use the diced method. I only suggest cartilage if you are undergoing a revision OR you want such a minor augmentation that its not too noticable. That way the irregularities of the cartilage won't be obvious. If you want a visible augmentation then go with the silicone. I wrote a post about rhinoplasty methods, its more of a rant lol but i discuss surgical perspectives between western and asian surgeons, open and closed rhino and the difficulty in cartilage grafts. Link to comment Share on other sites More sharing options...
mrsking Posted February 25, 2014 Share Posted February 25, 2014 Couture, Thank you for making such a great case in using silicon. My mind was pretty much made on rib cartilage for both of bridge and tip when I asked you the question, now I am not so sure any more. As a matter of fact, I think I am going to go with the soft silicon. I am so glad that I found this web site and your post! Link to comment Share on other sites More sharing options...
espressolatte Posted February 26, 2014 Share Posted February 26, 2014 Same here, MrsKing! I had almost been set on rib for years, but always had those reservations. Now I realize that soft silicone may also be the better alternative. Also yes, I will be sure to update the forum on my situation. I hope to get my rhinoplasty done in May so I have most of the summer break to heal. One thing that I still am a bit hesitant on silicone though is that it seems somewhere down the road, most people with silicone implants must get revisions or have it removed. It could be because of shifting, extrusion (is this possible with I-shape though?), infection, or the skin thinning. K Couture, could you give some insights on the long-term for silicone? Link to comment Share on other sites More sharing options...
k-couture Posted February 26, 2014 Share Posted February 26, 2014 There's been lots of people who have had I shape implants for years with no side effect, and others who have experienced it. That includes all the above u mentioned. While its less likely with cartilage, it is also still possible possible. Exhibit A right here /points to self ... One key thing to note is the placement of the implant. Alot of whether your implant will shift over time is determined by the implant's placement. Example, closed rhino generally takes more skill in order to get good placement when compared to open rhino. If not done properly the implant has a chance to shift to the side where the incision was made (from the nostril) because with artificial implants your body forms a leathery pocket around it. If implant entered from the right nostril, that leathery pocket could potentially push the implant slightly to the left. That is one reason why most surgeons in the West train in open rhino. Another reason is because caucasians don't typically require augmentations. Asians often require augmentations and as Roland K Daniel told me, usually if tip work is not required and only the bridge is to be operated on then closed is more desirable because it is less invasive. With regards to the Ultra Soft Silicone I have yet to hear bad things about it and the surgeon i selected said he has never experienced any problems with it. I was a bit skeptical but everyone who kindly responded to my thread about Dream who have used it didn't seem to have any issues with it. Anyway reason i selected Dream is because they offered me closed rhino for a second revision (which is rare cos every place else said i needed open which i am not comfortable with since i have internal scarring from the first open that left my nostrils slightly lopsided.). The method suggested was explained to me like this: approach through the right nostril, lift the muscle and place the ultra soft siicone on top of the bone and under the muscle. The muscle acts as a tight seal to protect the skin and also hold down the implant thus preventing movement. This sounded very logical to me. My only issue now is that after i spoke to Bryan Mendelson about this method he told me there's a chance my muscle might have already been damaged from the previous 2 rhinos. So there's no way to know until they open me up. Fingers crossed or i may have to use Auto Dermis and i don't even know much about that implant :S Anyways if i were you and you are going to clinics inquiring about Ultra Soft silicone, make sure you ask them their method to prevent movement of the implant and protrusion etc. If they can give you a logical explanation on the method, go seek a 2nd of 3rd opinion to see if its plausible. That should give you the best decision making ability oh and btw im going in May too! Link to comment Share on other sites More sharing options...
hyong Posted February 27, 2014 Share Posted February 27, 2014 Hi i had rib rhinoplasty ,8 months ago? rib cartiliage could be difficult to work with, and yes there may be minor imperfections , like i have a minor dent on mine bridge,just enough to annoy me, but still i would choose to have the dent,then revert back to mine previous nose,so it well....its not that bad,its just a matter of expectation . Link to comment Share on other sites More sharing options...
k-couture Posted February 27, 2014 Share Posted February 27, 2014 i totally get what you mean Hyong. Even tho my current nose has been damaged at the top of my bridge from the cartilage, i still acknowledge that it is better than my original nose. However, because i have seen the results i obtained from the silicone, is why i have chosen to get a 2nd revision to get that perfect shaped nose again minus the dodgey thailand implant. Link to comment Share on other sites More sharing options...
crissyq Posted February 27, 2014 Share Posted February 27, 2014 Anyone who has ever had a I-shaped silicone implant: What, if any, problems have you experienced and 1) how long have you had a silicone implant? 2) did you require a revision surgery? Also, would love to hear if from those who have had no problems whatsoever and for how long they've had the implant. I'm undecided about the soft silicone or rib cartilage as I would really, really like to avoid going back to Asia to get a revision in 5-10 years, or whenever needed. Thank you all for your input... I am hoping to book my flight and hotel in the next few days. Planning on going 2nd and 3rd week of April. Link to comment Share on other sites More sharing options...
shinyglittery Posted February 28, 2014 Share Posted February 28, 2014 i was considering the skin option too until i found out it comes from dead people... i think they don't tell you but you can probably get an infection from it! Link to comment Share on other sites More sharing options...
shinyglittery Posted February 28, 2014 Share Posted February 28, 2014 i think the above (Deb G) is not a real person. looks like it was written by a machine... Link to comment Share on other sites More sharing options...
k-couture Posted February 28, 2014 Share Posted February 28, 2014 oh i don't doubt there is a risk of infection. Even using your own grafts can risk infection. Its not just the material but the methodology and the pre op condition of your nose. That said i think it goes like this in terms of risk of infection: artificial implant > donor tissue/cartilage > .your own tissue/cartilage But then infections are not as common as people think. Most of the statistics available online for artificial implants don't particularize what type of artificial implant or method used. Is it goretex? Ultra soft silicone? I shaped silicone? L shaped silicone? Open rhino? Closed rhino? Each factor makes a difference when it comes to risk of infection. I personally would not have a problem using donor material lol. Haha Dr Park had this grin on his face when i asked him about the Auto Dermis. It went something like this: Me: Im not comfortable with your harvesting dermis from me.....it seems too invasive." Dr Park : oh no won't be harvesting it from you. Me: Then where is it coming from.....a dead person? Dr Park (smirks): Yes......its donor tissue.....manufactured donor tissue Haha i can totally understand how some people can be irked by the thought of having a dead person's tissue in you. But to me, as long as it looks good and is safe that's all that matters. Tho at this point im not sure if it poses the same aesthetic side effects as cartilage does :S Link to comment Share on other sites More sharing options...
espressolatte Posted February 28, 2014 Share Posted February 28, 2014 Thanks for your insight, Hyong! I agree with your last sentence. When you say 'expectation', what do you mean? I'm sure you had an ideal nose in mind before your surgery. How is your overall satisfaction with your nose after rib rhinoplasty? Link to comment Share on other sites More sharing options...
espressolatte Posted February 28, 2014 Share Posted February 28, 2014 Very informative post about the pros and cons of silicone, K Couture! I'm just scared that I'll suddenly have infection/extrusion during the middle of the school year. Apparently it can happen any time, and it doesn't seem there's a a time interval after which you're largely 'safe' from complications. I still have asked about Ultra Soft Silicone though, the material sounds very promising. I will also ask about their methods to prevent protrusion and infection like you suggested. I feel like I have to make a decision soon if I want to be able to go in May. I'm still very conflicted, this is a situation where having more options just further adds to the challenge! Link to comment Share on other sites More sharing options...
bitter-melon Posted February 28, 2014 Share Posted February 28, 2014 Have anyone heard about Bistool silicone for the implant? It is popular in Taiwan, they say it is the second generation of silicone, soft as well as comes with different sizes and shapes. How is the Ultra Soft comparing with Bistool? Does anyone know about this silicone materiel? Link to comment Share on other sites More sharing options...
k-couture Posted February 28, 2014 Share Posted February 28, 2014 huh it literally looks like another version of the ultra soft silicone but manufactured under a different name lol. The characteristics are so similar. Link to comment Share on other sites More sharing options...
mummymm Posted March 1, 2014 Share Posted March 1, 2014 Its is a newer generation of same material, an improved version, just a different name, that's all, that's what I was by nurse whilst consulting at a clinic. Link to comment Share on other sites More sharing options...
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