Key summary
Fibrous tissue forms around implants such as silicone. Contraction of this tissue can change the shape of the nose or displace an implant. People also seek revision because they are unhappy with the appearance or have breathing problems. A review of synthetic nasal implants reported an overall revision rate of 6.40%; the material-specific figures alone cannot establish a safety ranking. Cartilage has its own risks, including warping and resorption. The cause of the earlier problem and the condition of the tissue matter when planning a revision. PMID 35451637
Why is revision rhinoplasty performed?
Reasons include a result that does not match the person's goals, damage to structures involved in breathing, and persistent inflammation around an implant. Skin thickness, facial structure and the surgical plan all affect the choice of treatment. Inflammation around an implant can contribute to scar contracture and a change in shape.
Does the risk of revision differ by material?
The review of synthetic dorsal implants reported an overall revision rate of 6.40%, with separate estimates for silicone, porous polyethylene and expanded polytetrafluoroethylene. Patient groups, operations and follow-up periods differed, so those estimates do not establish which material is safest. They also do not include complications for which no revision operation was performed. PMID 35451637
Why does contracture around a silicone implant occur?
Excessive fibrous tissue around an implant can be associated with visible displacement and shortening of the nose. In a study of 695 patients followed for an average of 11.4 months, the authors described four grades: grade 1, 71.7%; grade 2, 14.5%; grade 3, 10.8%; and grade 4, 3.0%. Grades 3 and 4, which the authors considered surgical candidates, accounted for 13.8%. These figures are from that study and are not an individual prediction. PMID 28194349
The reviewer did not report a diagnosis of contracture. This is one person's account of a change in appearance and the materials discussed for revision, not evidence of a typical outcome.
Does open or closed surgery change the revision risk?
A systematic review reported revision rates of 2.73% for open and 1.56% for closed primary rhinoplasty; the difference was not statistically significant. The finding does not prove the approaches carry equal risks or establish that surgeon experience matters more than the approach. PMID 28050215
Is a person's own cartilage always safer than silicone?
No material is automatically safest for everyone. Cartilage can warp or be resorbed. A meta-analysis of 28 studies and 1,041 patients comparing the patient's own rib cartilage with irradiated donor rib cartilage reported pooled rates of 5% for warping and 2% for resorption. These pooled numbers combine both groups and are not rates for autologous cartilage alone. The study did not find statistically significant differences between the two groups for the reported complications. PMID 32077916
What do revision experiences show?
| Experience | Concern reported after earlier surgery | Subsequent treatment | Writer-entered payment |
|---|---|---|---|
| Silicone bridge | Starting point appeared unnatural over time | Own rib cartilage and septal cartilage | KRW 7,000,000 |
| Change in shape | Bend, broad tip and crooked appearance | Eye and nose revision together | KRW 6,250,000 |
| Persistent asymmetry | Asymmetry and upturned tip after a previous revision | Third nose operation | KRW 7,700,000 |
These are individual accounts, not verified clinical diagnoses, official clinic prices or average costs. The reviews illustrate different reasons for seeking further surgery.
What should I discuss before revision?
Tell the clinician what materials were used, how the appearance changed and whether you have breathing difficulties. The clinician can assess whether an internal examination or CT is appropriate. Ask what each examination is intended to show and how it will affect the plan; CT alone cannot identify every problem.
Material figures at a glance
| Material | Description | Reported figure | Considerations |
|---|---|---|---|
| Silicone | Synthetic implant | Revision 7.64% | Tissue changes around the implant |
| Medpor | Porous polyethylene | Revision 6.61% | Tissue integration with the porous material |
| Gore-Tex | Expanded polytetrafluoroethylene | Revision 4.91% | Infection and implant removal |
| Autologous rib cartilage | Cartilage taken from the patient's rib | Warping 5%, resorption 2% in pooled autologous and donor data | A donor-site procedure is required |
The first three figures come from PMID 35451637; the pooled cartilage figures come from PMID 32077916. The studies do not support ranking these materials by safety.
What should I consider in my situation?
| Situation | Discussion to have |
|---|---|
| First operation, mainly a tip concern | Ask about septal and ear cartilage and their suitability for your anatomy. |
| Revision or thin skin | Discuss available grafts, tissue condition and the reason each material is proposed. |
| Breathing difficulty | Include nasal function in the assessment and ask whether internal examination or imaging is needed. |
| Suspected inflammation or contracture | Identify the cause and discuss treatment; changing material alone does not necessarily resolve it. |
Common misconceptions
“Changing to my own cartilage will automatically fix revision problems.” Treatment depends on the cause, tissue condition and surgical plan; changing the graft alone may not address the problem.
“Open surgery is definitely much more likely to need revision than closed surgery.” One systematic review found no statistically significant difference in primary surgery. That result does not prove that the risks are identical.
Conclusion
Revision rhinoplasty has several possible causes, including the desired appearance, breathing problems and changes around an implant. Both synthetic materials and cartilage carry different risks. Discuss what went wrong in the earlier operation before choosing a new material.
Frequently Asked Questions
How much does revision rhinoplasty cost?
One reviewer entered KRW 7,000,000 for revision using rib and septal cartilage. This is an individual's reported payment, not an official clinic price or a population average. Ask for a written estimate that separates materials, anaesthesia and aftercare.
Why can the bridge look uneven after silicone removal?
Fibrous tissue around the implant can leave contours after removal. The treatment plan depends on the tissue seen during examination and surgery.
At what contracture grade is surgery needed?
The cited study regarded grades 3 and 4 as surgical candidates. An individual decision requires an examination and discussion of symptoms and options. PMID 28194349
How much rib cartilage is resorbed?
The cited meta-analysis reported 2% resorption in pooled data for autologous and irradiated donor rib cartilage. It is not an estimate for autologous grafts alone. PMID 32077916
How long should I wait after my first surgery?
There is no single interval suitable for every case. The timing depends on symptoms, tissue healing and the reason for revision; discuss it after an examination.
Consultation checklist
- Identify the materials used and the problem after the previous operation.
- Explain any breathing problems and ask whether an internal examination or imaging is useful.
- Ask how an existing implant would be managed and why a new material is recommended.
- Discuss the surgeon's experience with the type of revision you need.
- Separate promotional prices from the full estimate, including materials, anaesthesia and aftercare.
Sources and verification date
- PMID 35451637: systematic review and meta-analysis of 27 studies and 3,803 patients receiving synthetic dorsal implants; checked 2026-11-03.
- PMID 28050215: review of open and closed primary rhinoplasty; 1,271 abstracts screened and 49 studies included; checked 2026-11-03.
- PMID 28194349: contracture classification in 695 patients followed for 11.4 months, using 4 grades; checked 2026-11-03.
- PMID 32077916: meta-analysis of 28 studies and 1,041 patients comparing autologous and donor rib cartilage; checked 2026-11-03.
- Gangnam Unni review search, checked 2026-11-03. Payment figures are entered by the reviewers.
- Modoodoc nose-surgery categories, checked 2026-11-03.
Editorial responsibility and interests
Written and edited by the Korea Beauty Report editorial team. No medical reviewer is listed. First published 2026-11-03; last verified 2026-11-03.