Revision rhinoplasty using autologous rib cartilage for an upturned nose from contracture and nostril asymmetry

Preoperative design

The patient visited the clinic to correct excessive nostril show from the front and the appearance of a short nasal tip. This was their fifth revision rhinoplasty at our clinic, and they had a history of undergoing revision surgery after developing inflammation from silicone implant side effects during their third surgery.

2. Surgical plan

Suspecting a mild contracture deformity, we planned to assess the extent of internal nasal cartilage damage during surgery and reconstruct the cartilage using autologous rib cartilage. We also planned to remove the Gore-Tex implant from the nasal bridge and replace it with a silicone implant.

3. Immediately after surgery (Day 0)Immediate postoperative photos show swelling and may differ from the final result.

4. Conclusion

This patient had previously undergone surgery due to a silicone implant inflammation complication, resulting in a mild contracture deformity where the nasal tip shortened and turned upward alongside nostril asymmetry. A Gore-Tex implant was present in the nasal bridge, and approximately 30% of the lower lateral (alar) cartilage and septal cartilage was damaged; therefore, cartilage reconstruction was performed using autologous rib cartilage. In most cases of contracture deformity caused by inflammation, internal nasal cartilage damage is very common, and the more severe the contracture deformity, the more severe the cartilage damage. Therefore, the absolute foundation of contracted nose surgery is the reconstruction of damaged internal nasal cartilage. Up to about 6 months after surgery, there may not be a significant difference between cases with and without internal cartilage reconstruction, but as time progresses past 1 year, deformities develop if reconstruction was not performed.

Dr. Peter C. Kang