Why a crooked nose and irregular dorsum occur: implant removal and reconstruction methods

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who had a premaxillary implant from a previous surgery removed and achieved a natural yet refined nasal contour.

• 13 years ago: Nasal filler procedure

• 10 years ago: Silicone implant + ear cartilage surgery

• Same period: Revision surgery performed one week later due to a step-off between the bridge and tip

• 2024: 1 contouring injection treatment for nasal soft tissue

• 3–4 years ago: Forehead filler procedure

1. Front view

• Overall crooked nasal shape

• A harsh impression caused by a high radix starting point

• Uneven skin surface due to thin skin

• An unnatural overall appearance

2. Profile view

• High glabella

• Nose appearing long

• Uneven, irregular nasal dorsum surface

3. Nostrils

• Asymmetry between the left and right nostrils

• A columella noticeably tilted to the left

• Overall state of imbalance

• Natural yet defined nasal line

• A softer, youthful nasal shape

• Improvement of the uneven surface

• Correction of crooked nose

1. Foreign material removal

• Complete removal of foreign material in the glabella region

• Naturally lowering the high radix starting point that caused a harsh impression

• Careful removal of the premaxillary implant from the previous surgery

• Removal of a large amount of ear cartilage irregularly grafted into the right dorsal skin

• Dermal graft placement to achieve uniform skin thickness

2. Structural improvement

• Lateral nasal bone osteotomy performed to correct the crooked nose

• Septal extension using autologous rib cartilage to secure structural stability

• Lower lateral cartilage repositioning to improve tip shape

• Cartilage suturing (tip binding) performed for a natural tip contour

3. Functional improvement

• Septoplasty for deviated septum correction

• Radiofrequency submucosal resection of the inferior turbinates to treat hypertrophic rhinitis

• Improvement in overall breathing function and nasal obstruction

1. Front view

• The crooked nose has been symmetrically realigned

• The radix starting point was naturally adjusted to soften the harsh impression

• The previously irregular surface was smoothed

• A harmonious overall balance was established

2. Profile view

• Tip projection was appropriately increased, enhancing three-dimensional definition

• Radix corrected to a natural height

• A nose that previously appeared long was refined into balanced proportions

• Creation of soft, feminine contours and three-dimensional definition

• Improvement of the protruding mouth appearance by establishing a natural nasolabial angle after premaxillary implant removal

3. Nostrils

• Improved symmetry between the left and right nostrils

• The columella, which had been tilted to the left, was corrected

• A refined and balanced nasal tip shape achieved

This case presented complex problems resulting from irregularly grafted ear cartilage and a premaxillary implant from prior procedures. In particular, a large amount of ear cartilage placed beneath the right dorsal skin had created uneven skin thickness and an irregular surface.

To resolve these issues, we removed all of the existing ear cartilage and replaced it with a dermal graft to restore a more uniform skin thickness. In addition, we secured structural stability by performing septal extension with autologous rib cartilage and repositioning the lower lateral cartilages.

Although some unevenness may temporarily persist immediately after surgery, it is expected to smooth out naturally as the dermal graft stabilizes over time. By lowering the radix starting point and appropriately elevating the tip, we were able to deliver the natural, refined, and youthful look the patient desired.

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

Thank you.

#closedrhinoplasty #revisionrhinoplasty #foreignbodyremoval #crookednosecorrection #customrhinoplasty