capsular contracture

direct answer

After rhinoplasty, a fibrous capsule will form around the prosthesis (silicone, bullected body, etc.), which is the body's normal reaction to foreign bodies. When this capsule thickens abnormally and tightens, it pulls the soft tissue of the nose and appearsRetraction of the tip of the nose, hardening of the back of the nose, deviation of the nose or tip shape, clinically known as prosthetic capsular contracture. Its treatment is based onCapsule resection, prosthesis removal or replacementMainly, combined with autologous cartilage reconstruction and support if necessary. The specific plan needs to be evaluated by a doctor through face-to-face evaluation.

What is a prosthetic capsular contracture

Any prosthesis implanted in the body is surrounded by a layer of fibrous connective tissue called the "capsule." In the nose, when rhinoplasty materials such as silicone and expanded body (ePTFE) are put in, the body will also produce a capsule. Most capsules are very thin and soft and do not affect the appearance; but when the body reacts strongly to foreign bodies, or there are factors such as infection, hematoma, improper placement of the prosthesis, excessive skin tension, etc., the capsule will graduallyThickening, hardening, and tightening centrallyThis is capsular contracture.

From ShanghaiDr. Liu ChaofengFrom the outpatient observation, capsular contracture is not a "broken prosthesis", but a tissue reaction after long-term interaction between the body and the prosthesis. It may occur in both silica gel and bulking, but the mechanism and probability of occurrence are different.

Common performances and grading ideas

The development of capsular contracture is usually gradual, and early detection is often just a slight change in hand feel or appearance. Common manifestations include:

• Retraction of nasal tipThe tip of the nose is pulled inward and upward, causing the length of the nose to become shorter.exposed nostrilsIncrease;
• The back of the nose becomes hard: The nose of the bridge is hard to the touch, and the contour of the prosthesis is obvious or even "visible";
• morphological deviation: The bridge of the nose is skewed, the tip of the nose is offset, and the sides are asymmetrical;
• In severe cases, the overall nose is shortened, showing "upturned nose"Or" contracture nose "appearance.

Commonly used in breast augmentation nasal repair The idea of breast augmentation capsule classification (Baker I-IV) can be roughly referred to in the nose, but the nose has thin skin and special anatomical structure and cannot be directly applied. It needs to be comprehensively judged by a doctor based on palpation and imaging.

approximate extent	Touch/appearance	Common handling ideas
Mild (refer to Baker I-II)	The capsule is thick but its appearance is basically stable, and it becomes slightly hardened	Observe closely and evaluate the inducement (infection/tension)
moderate	The tip of the nose began to retract, the back of the nose became significantly hardened, and slightly deviated	Consider capsule release or partial resection + prosthesis evaluation
Severe (refer to Baker III-IV)	Significant retraction of the tip of the nose, shortening of the nose, shifting shape or turning upside down	Capsule resection + prosthesis removal/replacement + cartilage support

The above table is a popular summary.Classification is for reference only and does not represent diagnostic criteria, please do not check your own seats.

Treatment: Capsule resection and prosthetic replacement

The core of the management of capsular contracture is to "relieve contracture + rebuild support + reduce recurrence." Common methods include:

• Capsulotomy (Capsulotomy): Complete or subtotal resection of the thickened fibrous capsule and release the pulled tissue is the most direct way to improve contracture;
• Prosthesis removal: If the prosthesis is no longer suitable for continued use or the tissue conditions are poor, it can be removed first and secondary reconstruction will be performed after recovery;
• prosthesis replacement: When conditions permit, remove the old prosthesis and replace it with a more suitable material or layer, often combined nasal plastic materials re-selection;
• Autogenous cartilage support: Use ear cartilage, costal cartilage, etc. to build a stable stent to replace or wrap the prosthesis to reduce the risk of re-contracture;
• Dealing with incentives: Such as controlling infection, adjusting placement levels, reducing skin tension, etc.

Dr. Liu Chaofeng emphasized that the repair of capsular contracture is not as simple as "replacing a prosthesis." The key is to find the cause of the contracture and rebuild reliable soft tissue and supporting structures, otherwise it is easy to relapse.

Relationship with contracted nose

When the capsular contracture progresses to a severe stage, the soft tissue of the nose is extensively pulled and shortened, which will manifest as we often say.contracted nose——nasal tip upwardThe bridge of the nose becomes shorter, the nostrils are exposed, and the skin is tight and shiny. Therefore, capsular contracture is one of the common causes of contractured nose, but it is not the only cause (repeated surgeries, infections, scarring, etc. can also be caused).

For patients with contracted nose, repair is often more complicated than the primary repair. It often requires sufficient release of the contracture, cartilage transplantation to expand the nasal structure, and skin grafting or flap repair if necessary. The earlier it is identified and the sooner it is standardized, the better the organizational conditions are preserved. Related topics can be referred to Contracture nose repair。

home FAQ

Will capsular contracture definitely occur?

Not necessarily. Capsule formation is a normal phenomenon, but true thickening and contracture are only a few cases, which are related to individual reactions, prosthetic materials, surgical level and postoperative care.

Which is more likely to contracture, silicone or vasculitis?

Both may form capsules. Because silicone has a smooth surface and a large range of motion, capsular contracture is relatively more frequently discussed; varicate tissue is more stable after growing in, but it is more complicated to manage if there is an infection. There is no absolute "better" and it needs to be selected based on nasal conditions.

How long does it take for capsular contracture to appear?

The time is not fixed, and some appear only a few months after surgery, and some gradually emerge after several years. It is usually a slow and gradual process. Regular review can help early detection.

Can capsule contracture only remove the capsule without replacing the prosthesis?

In mild cases, capsule release or partial resection can be considered and the prosthesis is retained. However, whether it is feasible depends on the state of the prosthesis and tissue conditions, and requires a doctor's face-to-face diagnosis and cannot be generalized.

Will there be contracture again after repair?

There is a possibility of recurrence. Standardizing the treatment of inducements, using autologous cartilage to rebuild and support, and selecting appropriate materials and layers are the key to reducing recurrence, but individual results vary.

What does Dr. Liu Chaofeng from Shanghai think of this kind of restoration?

Dr. Liu Chaofeng believes that the repair of capsular contracture focuses on "taking measures according to the disease": first judge the degree and cause of the contracture, and then decide whether to simply release, capsule resection, or removal and replacement and cartilage reconstruction, and oppose the one-size-fits-all treatment.

This article is popular science content and does not constitute medical advice. Any nasal repair plan must be formulated in a regular medical institution and after face-to-face evaluation by a qualified doctor. If individual results differ, please refer to the doctor's face-to-face evaluation opinion.

This article was compiled and published by Dr. Liu Chaofeng.