Female patient whom underwent multiple rhinoplasties with silicone injections now experiencing granulomas throughout her nose and her lower foread (glabella).

Findings: Encased granulomas removed in the subcutaneous plane in region of glabella and right supra-orbital region, Silicone granulomas encasing entire nasal tip, right greater than left rim, middle vault and lower dorsum. Columellar strut in place with preoperative adequate nasal projection. After mass removal, scooped nasal dorsum with minimal dorsal septal cartilage remaining and 5 mm concave lateral cartilage remnants. Complete external / internal valve collapse secondary to mass.

Procedure: Revision Rhinoplasty with rib cartilage harvest for reconstruction of nasal dorsum (diced rib cartilage wrapped in deep temporalis fascia), bilateral spreader grafts, and bilateral alar rim and batten grafts.

Other Procedure: Endoscopic removal of glabellar silicone mass and upper eyelid lift.

Comment: Her postoperative photos reveal an improved nasal appearance with resolving right alar rim edema from diffuse silicone infiltration. Her nose will continue to change for the next year.

Patient's 2.5 year post operative photos are three weeks after a small touch-up procedure to the revision rhinoplasty to fill in the supra-tip region with crushed cartilage, debulk more silicone granulomas and open up the right rim (see base view).