Implant Types Used in Korean Rhinoplasty
실리콘 보형물 코성형 (sillikkon bohyeongmul ko-seonghyeong, silicone implant rhinoplasty) accounts for the majority of augmentation rhinoplasty procedures performed in Korea, where a low or flat dorsum is among the most common anatomical concerns in patients seeking nasal surgery. Korean board-certified plastic surgeons — there are approximately 2,100 registered with the KSPRS (대한성형외과학회, Daehan Seonghyeong Oegwa Haghoe, the Korean Society of Plastic and Reconstructive Surgeons) as of 2024¹ — use a defined set of implant and graft options, each with distinct properties, use cases, and risk profiles.
Solid silicone is not the same material as injectable or liquid silicone. Rhinoplasty-grade silicone implants are firm, pre-carved or custom-trimmed solid prostheses that sit in a pocket created beneath the nasal skin and periosteum (the membrane covering the nasal bones). They do not migrate into surrounding tissue and can be removed.
| Material | Primary use case | Revision difficulty | Tip extrusion risk | Current Korean surgeon preference |
|---|---|---|---|---|
| Silicone — I-shaped | Dorsal (bridge) augmentation only | Low — implant is encapsulated, not integrated | Low (tip not involved) | High — dominant primary augmentation choice |
| Silicone — L-shaped | Dorsal + tip augmentation in one piece | Low — same removal ease as I-shape | Moderate to high — tip arm presses on thin skin over time | Declining — used selectively |
| Gore-Tex (ePTFE) | Dorsal augmentation; patients with prior silicone complications | High — integrates with surrounding tissue | Low at tip (tip use uncommon) | Selective — minority preference |
| Septal cartilage | Tip grafting, columellar strut, minor augmentation | Not applicable — autologous graft | Negligible | High — first-choice tip graft source when adequate volume available |
| Ear cartilage | Tip grafting when septal supply is limited | Not applicable — autologous graft | Negligible | Moderate — second-line tip graft source |
| Rib cartilage | Structural revision, major augmentation, thin-skin patients | Not applicable — autologous graft | Negligible | High for revision and complex primary cases |
The right material depends on a patient’s anatomy, skin thickness, revision history, and the specific outcome being sought. No single implant type is appropriate for every patient.
The L-Shaped Implant: Why Korean Practice Has Changed
The L-shaped implant — sometimes called the L-strut — was the dominant rhinoplasty implant in Korean practice for several decades. Its appeal was straightforward: a single pre-formed piece of solid silicone augments both the nasal dorsum (the bridge from between the eyes to the tip) and the nasal tip in one surgical step, reducing operative complexity.
The structural problem with this design is the tip arm. The L-strut’s lower arm rests against the columella (the strip of tissue between the nostrils) and pushes upward against the nasal tip skin. Nasal tip skin — particularly in patients with thin skin — has limited tolerance for sustained pressure from a rigid implant over years and decades. The clinical result of this pressure over time is tip extrusion: the implant gradually erodes through the overlying skin and becomes visible or breaches the skin surface. Extrusion is a serious complication requiring implant removal and reconstruction.
A secondary issue is that the L-strut provides tip projection through mechanical force — pushing the tip upward — rather than through structural cartilage support. This can produce an unnatural tip appearance, particularly a boxy or overprojected look, that does not age well as the surrounding soft tissue changes.
Korean plastic surgery has collectively moved away from routine L-strut use in primary rhinoplasty as complication patterns became better documented through longer follow-up. Board-certified Korean surgeons completing the KSPRS’s required 4-year plastic surgery residency¹ are trained in both the historical technique and the risks that prompted the shift toward hybrid approaches. The L-shaped implant has not disappeared from Korean practice — it is still used selectively — but it is no longer the default.
Modern Hybrid Approach: I-Shape + Cartilage
The approach now dominant in Korean rhinoplasty for patients who want both dorsal height and tip refinement separates these two goals into two distinct materials: an I-shaped silicone implant for the bridge, and autologous cartilage — the patient’s own cartilage tissue — for the tip.
The I-shaped implant (also called a dorsal implant or dorsal onlay) runs from the radix (the root of the nose between the eyes) down to, but not including, the tip. It adds height and definition to the bridge without placing any silicone in contact with the thin tip skin. Because it does not extend to the tip, the primary extrusion mechanism of the L-strut is eliminated.
Tip work is then done separately using cartilage grafts. The preferred source, when available in sufficient quantity, is septal cartilage — harvested from the cartilage partition inside the nose itself, leaving no external scar and no chest donor site. When septal cartilage is insufficient (common in revision cases or patients with previously operated septa), ear cartilage or rib cartilage is used.
Autologous cartilage at the tip integrates with surrounding tissue over time, carries no extrusion risk, and allows the surgeon to shape tip projection and definition through structural techniques rather than implant pressure. The trade-off is operative complexity: the hybrid approach requires more surgical steps than a single L-strut placement and may extend operating time.
For patients with thin skin, prior implant complications, or significant structural tip needs, the hybrid approach or a full autologous cartilage reconstruction (rib cartilage throughout) is the standard of care in experienced Korean practices.
Questions to Ask Your Surgeon About Implant Choice
The implant discussion is one of the most consequential conversations in rhinoplasty consultation. These questions give you a structured way to assess your surgeon’s reasoning — and to verify their credentials before you have that conversation.
On credentials: Ask whether your surgeon is KSPRS board-certified. KSPRS maintains a public registry where you can verify certification by searching the surgeon’s name directly on the KSPRS website.¹ Board certification requires six years of medical school plus a four-year plastic surgery residency and passage of KSPRS board examinations.¹
On implant selection:
- “Are you recommending an I-shaped or L-shaped implant, and what is your reasoning for my anatomy?”
- “If you are recommending an I-shaped implant, where will the tip projection come from — cartilage grafting or another technique?”
- “What cartilage source would you use for my tip — septal, ear, or rib — and why?”
- “Have you reviewed my skin thickness, and does it affect your implant recommendation?”
On revision and removal:
- “If I needed this implant removed or replaced in ten years, how straightforward would that be?”
- “What is your personal revision rate for the implant type you are recommending?”
A surgeon who cannot give clear, specific answers to these questions — or who does not raise skin thickness and extrusion risk in the consultation unprompted — warrants careful consideration before proceeding.
Is a silicone nose implant safe long-term?
Solid silicone rhinoplasty implants have a long track record in Korean practice and are generally considered safe for most patients. The main long-term risks are capsular contracture (scar tissue forming around the implant), infection, and tip extrusion (the implant pushing through thin tip skin over decades). L-shaped implants carry higher extrusion rates than I-shaped implants at the tip. A well-placed I-shaped dorsal implant with autologous cartilage at the tip in a patient with adequate skin thickness has low rates of long-term complications.
What is the difference between a silicone implant and rib cartilage for rhinoplasty in Korea?
Silicone implant is a synthetic prosthesis placed under the skin — quick to place, no donor site, but carries small extrusion and infection risks. Rib cartilage harvests your own cartilage from the ribcage for grafting — it integrates with your tissue, carries no extrusion risk, but involves a chest donor site, longer surgery, and longer initial swelling. Rib cartilage is preferred for revision cases, patients with thin skin, structural tip work, or patients with prior implant complications. Most primary augmentation rhinoplasties in Korea use silicone (I-shaped) for the dorsum.
Can a silicone rhinoplasty implant be removed if I change my mind?
Yes — silicone implants can generally be removed relatively easily, which is one of their practical advantages over Gore-Tex (which integrates more deeply into tissue). Removal is possible at any time post-surgery, though removing an implant placed for many years may require correcting the resulting change in nasal shape. Removal-and-replacement (implant exchange) is a common revision procedure in Korea. Gore-Tex removal is technically more complex and may leave irregularities in the overlying tissue.
Sources
¹ Korean Society of Plastic and Reconstructive Surgeons — Board Certification Registry. [ksprs-registry-total-certified]; [ksprs-registry-training-requirements]; [ksprs-registry-public-verification]. https://www.plasticsurgery.or.kr/