Nasal prosthesis: rebuilding what surgery removed

A nasal prosthesis is a custom-made silicone replacement for the nose or part of it. It is not a generic appliance. Each one is sculpted specifically to your face, coloured to match your skin across its full range of tone, and finished with edges thin enough to disappear against the surrounding tissue.

Patients typically come to this after a rhinectomy for skin cancer, after an extensive Mohs procedure, following trauma, or when surgical reconstruction has been attempted and has not produced an acceptable result. Some patients choose a prosthesis instead of reconstruction from the outset, because it avoids further surgery and can produce a more natural result in a defect that is difficult to rebuild with tissue.

Impression and scanning

The process starts with a record of the defect and the surrounding face. This is taken with a conventional impression, a digital facial scan, or both. It is painless and takes under an hour.

Sculpting

The nose is sculpted in wax on a cast of your face. This is where most of the artistry sits. Where a pre-surgical photograph is available, the sculpt is matched to your own nose. Where it is not, the form is developed from facial proportion and from photographs you provide.

Try-in

You see and approve the sculpt before anything is made in silicone. Shape, projection, nostril form and how it sits against the surrounding tissue are all adjustable at this stage, and adjusting them here costs nothing but time.

Colouring and finishing

The silicone is intrinsically coloured to your base skin tone, then hand-tinted with the variation real skin actually has: the slightly redder areas, the small vessels, the freckling. Edges are feathered to near transparency so the margin is not visible at conversational distance.

Fabrication typically runs across several appointments over a few weeks. It is not a single-visit process, and any provider who suggests it is should prompt a question about how the colour matching is being done.

There are two established approaches, and the right one depends on your defect.

Adhesive retention

Medical-grade adhesive applied to the prosthesis margin. It requires no surgery, can be started as soon as tissue has healed, and is straightforward to learn. The trade-offs are daily application, adhesive residue that needs cleaning, reduced hold in heat and humidity, and gradual skin irritation for some patients.

Implant retention

Small craniofacial implants placed in the bone around the defect, connected to magnets or a bar-and-clip system. The prosthesis clicks on and off. Retention is substantially more secure, there is no daily adhesive, and positioning is identical every time. The trade-off is a surgical procedure and a healing period before the prosthesis can be loaded.

• It is removed at night and cleaned daily with mild soap and water.
• Most silicone prostheses last one to three years before the colour or the edges require replacement. Sun exposure is the main factor that shortens this.
• Glasses can usually be worn, and are often used to help conceal the upper margin.
• Swimming and showering are generally done with the prosthesis removed, particularly with adhesive retention.
• Breathing is through the prosthesis opening or the underlying airway, depending on your anatomy and the design. This is planned deliberately rather than left to chance.
• A second prosthesis is worth considering where budget allows, so that there is no period without one when the first is being remade.