How to correct a contracted nose and inflammation caused by residual foreign material

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who came to us with concerns about inflammation and contracture following multiple rhinoplasties.

• 2007: L-shaped silicone implant

• August 2021: Silicone implant + ear cartilage → Inflammation occurred

• November 2022: Silicone implant + mesh + alar base / premaxillary augmentation (cat surgery) → Upturned nose developed

• November 2023: Silicone implant + autologous rib cartilage + dermis + periosteum

• 10 days later: Treatment for inflammation (irrigation) and 16 sessions of PRP

• Contracture deformity (deformity caused by chronic inflammation)

• Abnormal edema (possible inflammation caused by residual foreign material)

• Nasal tip depression (silicone implant extending all the way down to the tip)

• Tenderness around the right philtrum (the area of paranasal augmentation)

• Persistent pulling sensation and discomfort in the left septal mucosa (caused by mesh remaining in the septum)

• Left-sided nasal obstruction (deviated septum)

1. Reconstruction of the lower lateral cartilage and septum using autologous rib cartilage

2. Alar lowering

3. Correction of the nasolabial angle

4. Stem cell therapy

5. Functional improvement (septal and rhinitis surgery)

6. Intravenous antibiotic injections

7. Septal reconstruction, foreign material removal, and skin grafting as needed

During the meticulous surgical procedure, the following issues were identified:

• The caudal end of the silicone implant was located immediately beneath the depressed area of the nasal tip.

• Residual mesh was identified in the left septal mucosa of the tip and removed.

Fragments of mesh removed during surgery

• Removal of an autologous rib cartilage fragment deviated to the right at the paranasal augmentation site

• Chronic foreign body reaction and inflammatory response caused by residual foreign material appeared to have been present.

-> Completely removed and thoroughly irrigated

• Most of the septal cartilage had been lost, and the remaining septum was deviated to the left.

-> Septal reconstruction was performed using autologous rib cartilage.

• Because there was insufficient skin while correcting the shortened nose, retroauricular skin was grafted to both sides of the columella.

1. Front view

• Retracted nostrils

• Pinched alae

• Asymmetry

• Deviated nasal bridge

• Nasal bone asymmetry

2. Profile view

• High radix starting point

• Short and collapsed nasal tip

• Obtuse nasolabial angle

• Upturned nose

3. Nostrils

• Left-right asymmetry

• Columella tilted to the left

• Pinched nostrils

1. Frontal view improvement

• Correction of retracted nostrils

• Improvement of pinched alae

• Improved asymmetry

• Straight bridge line

2. Profile view improvement

• Natural radix starting point

• Stable tip shape

• Appropriate nasolabial angle

3. Nostril improvement

• Improved symmetry

• Centrally positioned columella

• Natural nostril shape

This was a case of a contracted nose resulting from inflammation caused by previous failure to completely remove mesh material.

Notably, the implant placed along the bridge extended down to the tip, typical skin depression was observed where it pressed against the nasal tip, and normal cartilage tissue was severely damaged by chronic inflammation.

All inflamed tissue was removed, and every area of damaged normal tissue was reconstructed, which is expected to naturally improve the nasal obstruction that had developed as a result. Furthermore, the contracture deformity—where the tip had twisted and turned upward—was successfully improved through stem cell therapy and reconstruction using autologous rib cartilage.

By combining active intravenous antibiotic therapy with stem cell treatments during the recovery period, I expect the patient to recover smoothly.

I hope this case helps those who are experiencing similar concerns.

This was Dr. Peter C. Kang. Thank you.

Thank you.

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