Histological and Radiological Characteristics of Calcification Around Nasal Silicone Implants

An Educational Review Based on Clinical Analysis by Yong-Seon Hwang, Taek-Kyun Kim, Dong-Jun Yang, Si-Hyong Jang, Da-Woon Lee

Introduction Silicone implants are commonly used in rhinoplasty due to their stability and ease of manipulation. However, long‑term implantation can be associated with complications, including inflammation, capsular contracture, implant deformation, and notably, periprosthetic calcification. Although calcification has been documented in other silicone prostheses (e.g., breast implants, ophthalmological sheets), rigorous characterization in the nasal context has been limited. The clinical analysis by Dr. Taek Kyun Kim provides novel insights into how calcification manifests around nasal silicone implants, integrating histological and radiological data to guide clinicians in diagnostic evaluation and surgical planning. Clinical and Demographic Overview

In Dr. Kim’s study, 16 patients (mean age ≈ 41.6 years, implant duration 4–20 years) who underwent revision rhinoplasty for implant‑related complaints were evaluated. All had straight hard‑type silicone implants, and reasons for revision included implant deviation and aesthetic deformities. Histological evidence of inflammation was seen in a subset (37.5%), though bony erosion was not identified on imaging.

Fig. 1. Investigation of the reasons for revisional rhinoplasty based on medical records revealed that the primary concern was deformity in nasal shape, with implant deviation being the most common reason in eight patients (50%). All 16 patients had consistent implant types, utilizing hard-type straight "I" shape silicone implants. Inflammation around calcification in the skin soft tissue envelope was observed in six patients (37.5%), while no bony erosion was detected in the seven patients who underwent CT imaging.

Radiological Characteristics CT Imaging and Hounsfield Units

Computed tomography (CT) was used to assess the density and extent of calcification:

• Calcified regions were identified as hyperdense shells or foci surrounding the implant.

• Median Hounsfield Unit (HU) values of calcified lesions ranged widely (456–2746), indicating variable mineralization densities.

• There was a positive correlation between implant duration and HU value (Spearman ρ ≈ 0.618), though this trend did not reach statistical significance (P = 0.139).

Location of Calcification

Calcification was most commonly located in the tip dorsum (TD) region (56% of cases), followed by cephalic dorsum (CD), cephalic base (CB), and tip base (TB).

This predilection for TD may reflect:

• Greater mechanical motion and friction at the mobile cartilaginous tip compared with static bony areas.

• Higher interface stress between implant and soft‑tissue envelope during nasal movement.

Histological Features Gross and microscopic analyses of explanted specimens revealed characteristic findings:

• Calcified capsules enveloping the silicone implant material were evident grossly.

• Histologically, amorphous basophilic deposits surrounded by fibrotic tissue were identified, consistent with dystrophic calcification rather than metastatic mineralization.

• Surrounding peri‑implant stroma frequently showed:

  • Mild lymphocytic infiltration

  • Multinucleated giant cells

  • Sparse chronic inflammatory cells
    

These features support the concept that calcification arises in the context of chronic low‑grade tissue responses and fibrotic capsule formation.

Fig. 2. Histopathologic findings of calcified nasal implant. A: Calcified material surrounded by fibrotic tissue. Amorphous, irregular-shaped, basophilic deposits (orange arrowheads) suggesting dystrophic calcification were found surrounding the foreign material and fibrous tissue; B: Adjacent soft tissue exhibits a mild lymphocytic infiltration and a few foreign body-type giant cells (yellow arrowheads). Hematoxylin and Eosin staining, 500 μm.

Fig. 3. Histopathologic findings of peri-implant tissue. A: Dispersed multinucleated giant cells (orange arrowheads) in the surrounding fibrotic stroma; B: Sparse lymphocytic infiltration (yellow arrowheads) is also observed in the stroma. Hematoxylin and Eosin staining, 200 μm Proposed Pathophysiology Several mechanisms have been hypothesized for implant‑associated calcification, including:

1. Chronic Inflammation: Persistent low‑grade inflammatory responses may drive dystrophic mineral deposition within fibrotic tissues.

2. Mechanical Friction: Continuous motion between implant and surrounding soft tissue, particularly at the mobile nasal tip, may amplify tissue stress and stimulate calcific nodule formation.

3. Surface Chemical Interactions: Anionic sites on silicone surfaces potentially bind calcium cations, promoting mineral deposition.

4. Tissue Microenvironment: Local pH changes due to microdamage or bacterial metabolism could favor calcium phosphate precipitation.
   

These factors are not mutually exclusive and likely interact over time to produce the observed calcific pathology.

Fig. 4. Computed tomography findings of calcified nasal implant. A: A thick calcified capsule observed on the implant; B: Extensive peri-implant calcification surrounding with the right-side deviated implant. Clinical Implications

Awareness of implant calcification is important for clinicians because:

• Preoperative imaging: Recognizing high‑density peri‑implant calcification on CT aids in surgical planning, especially for revision rhinoplasty.

• Differential diagnosis: Extensive calcification could be misinterpreted as bone formation or hypertrophic nasal bone on imaging.

• Material selection and technique: Utilizing softer silicone implants and minimizing perioperative trauma may lower the risk of calcification, as suggested by biomechanical tests showing reduced rigid stress with softer implants.

Fig. 5. Computed tomography findings of calcified nasal implant. A: A thick calcified capsule observed on the implant; B: Extensive peri-implant calcification surrounding with the right-side deviated implant. Conclusion Calcification around nasal silicone implants is a significant, albeit under‑recognized, long‑term complication in rhinoplasty. Based on histological and radiological evidence from Dr. Taek Kyun Kim’s study:

• Calcification most frequently localizes to the tip dorsum region.

• CT imaging shows variable HU values that tend to increase with implant duration.

• Histologically, dystrophic calcification within a fibrotic capsule, with variable chronic inflammatory features, predominates.

A thorough understanding of these characteristics supports improved diagnostic accuracy and may inform preventive strategies in implant selection and surgical technique. Reference:

1. Taek Kyun Kim, Complicated Calcified Alloplastic Implants in the Nasal Dorsum: A Clinical Analysis,

   World J Clin Cases, 2024;12(18):3351–3359.

2. Additional relevant literature on silicone implant complications, dystrophic calcification, and rhinoplasty revision techniques.

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