Nose Implant Rejection and Allergies, and Which Rhinoplasty Material to Choose

People with allergies often worry, “Can I have rhinoplasty?”, “Will I be allergic to the material?” and “Which material should I choose?” Research has found that people with allergies have a 2 to 3 times higher risk of inflammation than other people.

So how can people with allergies have rhinoplasty, which rhinoplasty materials have a lower chance of allergy and inflammation, and how should you prepare? This article explains.

How Allergies Affect Rhinoplasty

An allergy is when the immune system does not work normally and overreacts to harmless substances (allergens), such as:

• pollen, dust and dust mites
• pet hair
• food (prawns, crab, eggs, milk)
• medicines (penicillin, aspirin)
• chemicals (cleaning products, perfume)

People with allergies have an overactive immune system (hyperactive immune system). This means they are more likely to be allergic to rhinoplasty materials (especially silicone), and have a higher chance than other people of chronic inflammation, the body rejecting the implant, slow wound healing and hardened tissue.

Which Type of Rhinoplasty Lowers the Risk of Allergy?

Your Own Cartilage (Autologous Cartilage)

Autologous cartilage means taking cartilage from your own rib, ear or septum to augment the nose. From past cases of people with allergies who wanted rhinoplasty, the chance of allergy is low because it is your own tissue, which the body accepts, lowering the risk of inflammation. Your own cartilage can also move with the nose and is not rigid.

Rhinoplasty with your own cartilage is complex surgery, done as open rhinoplasty, and cartilage must be taken from another site (2 incisions). It costs more, at THB 80,000 to 200,000 (depending on how difficult it is).

• suitable for people with severe allergies
• suitable for people who have had silicone rhinoplasty and had an allergy or inflammation

PCL (Polycaprolactone), a Synthetic Material for People With Allergies

PCL (polycaprolactone) is a synthetic material that is biodegradable and is replaced by your own tissue within 2 to 3 years. It is highly biocompatible, which lowers the risk of the body rejecting it or of an allergy. Over time, the synthetic material is replaced by your own tissue, giving a soft feel and letting it move with the nose.

• suitable for people with moderate to severe allergies
• suitable for people who do not want surgery to take their own cartilage

Gore-Tex (ePTFE)

Gore-Tex (ePTFE) is a soft, porous material that lets tissue grow into it. For people with allergies, the chance of allergy is low. It is biocompatible, feels soft and moves more easily than silicone. Its pores help tissue grow into it so it holds in place well, it is not see-through so it does not show a shadow, and the surgeon can trim and shape it as needed.

• suitable for people with mild to moderate allergies
• suitable for people who want a soft material
• suitable for people who do not want 2 incisions

Silicone is not recommended for people with allergies.

Preparing for Rhinoplasty If You Have Allergies

• tell the surgeon about all your allergies (food, medicines, chemicals, dust), what you have been allergic to and what the symptoms were
• tell the surgeon about any medicines you take regularly, such as antihistamines
• have a consultation with the surgeon about which material suits you
• have an allergy test, such as testing silicone, Gore-Tex and PCL, to see whether you get a rash, itching, redness or swelling
• prepare your immune system 2 to 4 weeks before surgery by avoiding things you are allergic to so your immune system is calm, stopping antihistamines 1 to 2 weeks before (as your surgeon advises), getting enough rest so your immune system works well, and eating healthy food such as vegetables, fruit and protein
• have a health check, blood tests (CBC, allergy panel) and an IgE test (high means a more severe allergy), and if your IgE is very high, surgery may need to be delayed so the allergy can be treated first

Aftercare After Rhinoplasty If You Have Allergies

Weeks 1 To 2

• take medicines on time, including antibiotics and anti-inflammatory medicines
• rinse your nose with saline 3 to 4 times a day to wash out germs
• do not pick blood crusts, as this can cause infection and inflammation
• avoid things you are allergic to, to let your body recover
• sleep with your head raised at 30 to 45° to reduce swelling

Months 1 To 3

• watch for signs of inflammation, such as redness, swelling, warmth or pus
• go to follow-up appointments with the doctor in weeks 1, 2, 4, 8 and 12
• avoid dust and smoke, and wear an N95 mask
• do not massage your nose, to let the wound heal fully

Months 4 To 12

• monitor your symptoms to see whether there is a chronic allergy
• go to follow-up appointments with the doctor in months 6 and 12
• if you notice anything unusual, see a doctor straight away

Frequently Asked Questions

If I Have a Mild Allergy, Can I Use Silicone?

Even with a mild allergy, silicone carries a high risk (a 5% to 15% chance of allergy). If you want a lower risk, Gore-Tex, PCL or cartilage are recommended instead, as they carry a much lower risk (0% to 5%).

Does Your Own Cartilage Really Shrink After Rhinoplasty?

Slightly. Cartilage may be absorbed by 10% to 20% in the first year, but after that it usually stays stable for the long term (15 to 20 years or more). Experienced surgeons add extra (overcorrection) to make up for this. For example, if you want 5mm more height, they use 6mm to 7mm so that about 5mm remains after absorption.

If I Had an Allergy to Silicone, Can I Change to Cartilage?

Yes. Have a consultation with a doctor for advice for your situation.