Introduction

In 2025, New York City continues to be at the forefront of medical innovation, especially when it comes to silicone prosthesis implantation for padding the nasal basal. This procedure has become increasingly popular for both aesthetic and reconstructive purposes. Patients from all over the world seek the advanced technology and expertise available in the city's hospitals. This article will explore the various technologies and techniques used in hospitals for silicone nasal prosthesis implantation in New York City, highlighting their benefits, potential risks, and the overall impact on patient outcomes.

Understanding Silicone Nasal Prostheses

Silicone nasal prostheses are synthetic products used to alter the size, shape, or overall structure of the nose. They can be placed for aesthetic reasons, such as enhancing the nose's appearance during rhinoplasty, or for functional purposes, like strengthening the nasal valve area to improve breathing. Silicone is a popular choice for these prostheses due to its good biocompatibility, easy tailoring, and affordability.

Advantages of Silicone Nasal Prostheses

• Biocompatibility: Silicone is well - tolerated by the human body, reducing the risk of severe allergic reactions compared to some other materials.
• Customization: It can be easily carved and shaped by surgeons to match the patient's unique nasal anatomy and aesthetic goals.
• Availability: Silicone prostheses are readily available in different shapes and sizes, making them a convenient option for many surgeries.
• Cost - effective: Compared to some other nasal implant materials, silicone is relatively inexpensive, making it accessible to a wider range of patients.

Disadvantages and Potential Complications

• Infection: One of the major concerns is the risk of infection. If an infection occurs, it can be difficult to treat with antibiotics, and in some cases, the implant may need to be removed. According to some studies, the overall complication rate related to silicone nasal implants can be around 9.2% (Hoang et al, 2018).
• Implant deviation or displacement: Silicone implants may move from their original position over time, leading to an asymmetrical or unnatural appearance of the nose.
• Translucency: In some cases, the implant may become visible through the skin, especially in areas where the skin is thin, causing an unnatural appearance.
• Capsular contracture: The body may form a fibrous capsule around the implant, which can cause the nose to feel hard and may distort the shape of the implant.

Technological Advancements in Silicone Nasal Prosthesis Implantation

Novel Silicone Implant Designs

Jianjun Zhang introduced a novel silicone nasal implant in a study. This implant is designed to reduce postoperative complications associated with traditional silicone implants. The implant has several unique features:

• Convex particle surface: The dorsal side of the implant has a convex particle surface with countless granular projections. This surface can form a diffuse reflection, reducing the risk of translucency. It also allows fibrous tissue ingrowth, increasing the resistance against sliding down and reducing the possibility of deviation.
• Horizontal and vertical grooves: There are 12 to 16 horizontal grooves on both sides of the main vertical ventral groove. These grooves increase the friction, preventing the implant from sliding down. They also make the implant softer to the touch and reduce its overall weight, effectively preventing deviation and reducing the risk of capsule contraction.
• “Mantis neck” design: A narrowed neck is located at the junction of the tip and body of the implant, imitating the human nose tip structure where the alar cartilages connect to the nasal bone. This design allows the tip of the implant to swing freely without moving the nasal bridge.
• Hollow nose tip: The implant is intentionally hollowed at the tip, enabling a soft nose tip after surgery.
• Vertical board: A thin, vertical board (columella) is connected to the tail of the nasal septum, providing enough support to the nasal tip without increasing the width of the columella.

In the study, 114 consecutive clinical cases were retrospectively reviewed from September 2016 to November 2022. The overall complication rate was 4.39%, and 95.61% of the patients showed satisfying results without any postoperative complication. None of the patients with primary surgery reported postoperative complications.

3D Printing Technology

3D printing technology has revolutionized the field of silicone nasal prosthesis implantation. With the increasing demand for customized implants, 3D printing allows for more accurate and personalized prostheses. In a study by Inhee Lee et al., they compared a 3D customized nasal implant design with a manually customized implant by a surgeon.

Based on the computed tomography (CT) findings of 15 patients, engineers analyzed the CT data and designed 3D implants according to order forms filled by surgeons. The results showed that in all parameters, such as nasion thickness, tip thickness, glabella starting point, glabella width, radix width, and total volume, the error rate of the 3D design was relatively lower than that of the epoxy design (a traditional manual design method). The 3D - designed implants also had a lower total volume and a faster manufacturing time.

The use of 3D printing technology addresses the limitations of ready - made silicone implants. It allows for pre - operative design review, ensuring a better fit to the patient's nasal anatomy and reducing the risk of complications such as deviation and gaps between the bone and the implant. This technology enables the production of implants that are more suitable for individual facial structures, leading to higher patient satisfaction.

Digital Technology in Workflow

Digital technology has also been integrated into the workflow for osseointegrated implant - retained nasal prostheses. Lindsay McHutchion et al. described a case where digital technology was used in the treatment of a patient with an osseointegrated implant - retained nasal prosthesis.

The surgery was planned digitally to determine the optimal implant positions. Implant placement surgical guides were digitally designed and additively manufactured. Prosthetic components, including the nasal form and substructure, were simulated digitally. Based on this simulated prosthetic model, patient - specific abutments were digitally designed and copy - milled. Prototypes for the substructure and prosthesis were 3D printed. Spectrophotometry and computerized color formulation were used to generate the silicone base color of the prosthesis, and characterization was performed by eye.

The integration of digital technology allowed for optimized prosthetic retention, predictable esthetic outcomes, and reduced patient appointment time. It ensured that implants were located optimally for prosthetic design and allowed for a more efficient and precise treatment process.

Patient Evaluation and Selection

Before silicone prosthesis implantation, a thorough patient evaluation is crucial. Surgeons in New York City hospitals follow a comprehensive pre - operative assessment process to ensure the safety and success of the procedure.

Medical History and Physical Examination

Patients are asked to provide their medical history, including any previous nasal surgeries, allergies to medications, and underlying health conditions. A physical examination of the nose is performed to assess the nasal figure, the level of nasal deformity, and the condition of the nasal tissues. The surgeon also inspects the patient's face contour to ensure that the planned implant will fit harmoniously with the overall facial features.

Pre - operative Consultation

During the pre - operative consultation, the surgeon discusses the patient's aesthetic goals and expectations. It is important for patients to have realistic expectations about the outcome of the surgery. The surgeon explains the procedure, the potential risks and complications, and the expected recovery period. The choice of prosthetic model is also discussed based on the patient's desires and the anatomical features of their nose. Surgery is only performed after obtaining the patient's written informed consent.

Contraindications

Patients may not be suitable candidates for silicone prosthesis implantation if they have certain conditions. These include a false perception regarding the safety of the silicone implant, disagreement with the implant design, unrealistic expectations regarding the outcomes of the surgery, or the presence of active infections or ulcerations on the nose. Additionally, patients who have a history of severe allergic reactions to silicone or other materials used in the implant may not be eligible for the procedure.

The Implantation Procedure

Pre - operative Preparation

Before the surgery, the hair inside the nostril is trimmed, and the secretions in the nasal cavity are cleaned. Patients undergo a series of laboratory tests, such as routine blood tests for liver function, kidney function, and blood sugar, to ensure their overall health. The type of anesthesia is determined based on the patient's tolerance and the complexity of the procedure. For primary surgery, local anesthesia consisting of 1% lidocaine mixed with 1:100,000 epinephrine is commonly used. For patients who cannot tolerate the pain of local anesthesia injection, intravenous anesthesia or general anesthesia with tracheal intubation may be used for longer or more complex surgeries.

Surgical Technique

The surgeon first makes a wing - shaped open incision at the columella. The incision is extended along the nostril edge of the nasal columella to the right and left alar, taking care to ensure that the incision is located 2 mm away from the bilateral alar rims. The skin of the nasal columella close to the surface of the alar cartilage is lifted to expose a part of the bilateral alar cartilage. A subperiosteal dissection is then performed above the surface of the nasal bone and under the deep fascia, creating an adequate prosthesis pocket for the implant.

In revisional surgeries, the removal of a previous implant or residual cartilage may be necessary. If the patient has a history of hyaluronic acid injection, the prosthesis pocket is rinsed thoroughly to ensure no hyaluronic acid is left inside. The implant is then carved either before sedation or after the pocket space is created. The carving is done to ensure a smooth transition between the implant and the forehead, a moderately narrowed horizontal canthus part, and a proper width and thickness corresponding to the tendon stone area. The lower half of the implant near the nasal tip is also narrowed, and holes are punched in the implant to improve blood circulation and tissue integration.

The carved implant is inserted into the surgical pocket and adjusted to a central position. A deep cavity is dissected into the caudal end of the nasal septum for the insertion of the vertical board of the prosthesis. The vertical board is inserted into the cavity as the medial foot of the bilateral alar cartilage, and the bilateral fornix of the alar cartilage is sutured to fix the prosthesis in place. After the patient, if under local anesthesia, has approved the postoperative result using a mirror, the incisions are closed, and a thermoplastic plate is applied to fix a compress bandage for 72 hours. The suture is removed on the eighth postoperative day.

Post - operative Care and Follow - up

Immediate Post - operative Care

After the surgery, patients are closely monitored in the recovery room. They may experience some swelling, pain, and difficulty in breathing, which are normal in the initial stages of recovery. Ice packs may be applied to the nose to reduce swelling, and pain medications are prescribed as needed. Patients are advised to rest with their head elevated to minimize swelling.

Recovery Period

In the first stage of wound healing, which usually occurs within 2 weeks after surgery, patients are advised to use a silicone nasal dilator to improve breathing and nasal airflow. This device also helps in shaping the postoperative nose and fixing the nasal columella. Swelling is common during this period, especially in revisional surgery, and asymmetry caused by uneven swelling is acceptable.

From 2 weeks to 3 months after surgery, the wound should complete the initial phase of healing. Patients are monitored for the occurrence of any infection, redness, deviation, sliding, or implant exposure. Nose function should gradually regain normalcy during this time.

After 3 months, the nose should regain complete normalcy with no surgical complications. The appearance of the nose becomes the most important factor in patient satisfaction. The implant should be well - integrated into the nasal structure and not be visible from the outside nor have any deviation.

Long - term Follow - up

Patients are scheduled for regular follow - up appointments to monitor the long - term outcome of the surgery. The follow - up period can range from several months to years. During these appointments, the surgeon assesses the function and appearance of the nose, checks for any signs of complications, and addresses any concerns the patient may have. Long - term follow - up is essential to detect and manage any potential late - onset complications, such as implant degradation or changes in the nasal tissues.

Comparison with Other Nasal Implant Materials

Hyaluronic Acid

Hyaluronic acid is a popular non - surgical option for nasal augmentation. It is injected into the nose to add volume and reshape the nose. The main advantages of hyaluronic acid injection are its convenience and short recovery period. However, it also has some limitations. Vascular complications are a serious concern, as intravascular injection or the compressive effect of the filler on local vessels might lead to extensive skin necrosis. The long - term appearance of rhinoplasty with hyaluronic acid injection is usually not satisfactory, as the nasal dorsum may start to widen after injection. In contrast, silicone prostheses provide a more permanent solution and can be better tailored to the patient's specific needs.

Expanded Polytetrafluoroethylene (ePTFE)

ePTFE is a porous material that allows tissue ingrowth, which might prevent migration of the prosthesis and minimize contracture. However, due to its porous structure, removal can be complicated. Lack of capsule formation also means that implants are closer to the skin and more visible. Moreover, ePTFE is associated with a relatively high risk of postoperative infections, as microbes can enter the micropores, but macrophages cannot target them. Silicone prostheses, on the other hand, are easier to remove if necessary and have a lower risk of certain types of infections compared to ePTFE in some cases.

Autologous Cartilages

Autologous cartilages, such as costal cartilage or septal cartilage, are biocompatible and have near - zero infection and resorption rates. However, harvesting cartilage from the body involves an additional surgical site, which can lead to donor site pain, scarring, and other complications. Costal cartilage harvesting can also carry the risk of pneumothorax. Additionally, in some patients, the harvested septal cartilage may not provide sufficient material to achieve an ideal tip projection. Silicone prostheses offer a less invasive alternative without the need for cartilage harvesting.

Conclusion

In 2025, New York City hospitals are equipped with advanced technology for silicone prosthesis implantation to pad the nasal basal. The novel implant designs, 3D printing technology, and digital workflow integration have significantly improved the safety, effectiveness, and aesthetic outcomes of the procedure. These advancements address many of the traditional concerns associated with silicone nasal prostheses, such as postoperative complications and the fit of the implant. However, patient evaluation, careful surgical technique, and proper post - operative care remain crucial for the success of the surgery.

If you are considering silicone prosthesis implantation for nasal basal padding, it is essential to have an in - depth discussion with a qualified surgeon. They can provide you with detailed information about the procedure, the potential risks and benefits, and help you make an informed decision. Share this article with others who may be interested in learning more about this advanced medical technology, and explore related topics on nasal aesthetics and reconstructive surgery to gain a comprehensive understanding of your options.