Background <p>Augmentation rhinoplasty using alloplastic materials, especially silicone, is widely performed in Southeast Asia. Besides delivering sufficient volume augmentability, silicone implants are favored due to their superior malleability and biocompatibility. Silicone implant insertions are associated with complications, but there is a paucity of late complications reported two decades post-insertion.</p> Case presentation <p>We present a rare case of nasal tip extrusion of a silicone implant 40&#xa0;years after augmentation rhinoplasty in a 78-year-old woman. The patient came to us with nasal tip implant extrusion 6&#xa0;months after an unprovoked nasal vestibular abscess. Physical examination revealed a partially extruded implant at the nasal tip with no signs of infection. Imaging did not reveal any peri-implant collection, and the extruded implant was removed. The patient had a stormy recovery with recurrent culture-positive pus discharge from the previous cavity of implant placement, which resolved after multiple wound debridements and targeted antibiotic administration.</p> Conclusions <p>The common complications are capsular contracture, calcification, infection, displacement, and extrusion. Most complications had a comparably early onset within the first few years after rhinoplasty. Due to the possibility of the occurrence of long-term complications related to silicone implant rhinoplasty, a high level of suspicion is paramount to detect delayed complications such as delayed extrusion.</p>