Aged nasal implants and nasal pain: key points to evaluate in revision rhinoplasty

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce a unique case involving an older patient with a 50-year surgical history.

I will explain in detail the surgical plan, structured with safety in mind considering underlying medical conditions, and the operative process.

• Arrhythmia

• Hyperthyroidism

• Hyperlipidemia

• Currently taking blood pressure and thyroid medications

• 50 years ago: L-shaped silicone implant (implant extruded through the columella after bumping into a door)

• 30 years ago: silicone implant surgery

• 3 to 4 years ago: silicone implant, ear cartilage, and septal cartilage surgery

• High and straight nasal bridge

• A line with balanced volume

• Harmony with the overall face

• Relief of pain in the left nostril

Before surgery / Day 0 immediately after surgery Photos taken immediately after surgery show swelling and may differ from the final result.

1. Front view

• Pointed nasal tip

• Nostril asymmetry

• Nose deviated to the left

• Uneven nasal bridge

2. Profile view

• Pointed nasal tip

• Unnatural nasal dorsum line

• Upturned nose

• Protruding mouth findings

• Long philtrum

3. Nostrils

• Left-right asymmetry

• Columella tilted to the left

Before surgery / Day 0 immediately after surgery Photos taken immediately after surgery show swelling and may differ from the final result.

Taking advanced age and underlying conditions into account:

• Donor rib cartilage chosen to minimize operative time

• Performed under the supervision of a board-certified anesthesiologist

• Safety prioritized above all

Contrary to the documented surgical history, donor rib cartilage had been placed in the nasal tip, and the site where this donor rib cartilage was anchored to the septal cartilage matched the exact area where the patient reported pain, confirming it as the source of discomfort. Therefore, I removed the existing cartilage and secured new donor rib cartilage in an alternative position.

1. Front view improvement

• Natural volume

• Improved nostril asymmetry

• Corrected deviation

2. Profile view improvement

• Improvement of upturned nose

• Rounded nasal tip

• Natural nasolabial angle

3. Nostril improvement

• Improvement of asymmetry

• Straight columella

In this era of the 100-year life expectancy, rhinoplasty among older adults is increasing. However, because older patients carry anesthesia-related risks, surgery must be performed with an anesthesiologist present to support safety.

In this case as well, we established a surgical plan designed with safety in mind, carefully considering the patient's underlying conditions and age, and achieved a satisfactory outcome by addressing the patient's requests.

I will continue to do my best to deliver safe and satisfying outcomes for patients of all ages.

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

Thank you.

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