Why replacing a cartilage nasal tip with an L-shaped silicone implant causes problems

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a structural reconstruction case of a patient who had undergone surgery where the implant was unexpectedly replaced with an L-shaped silicone implant following a previous rhinoplasty.

• 10 years ago: Septal cartilage and ear cartilage were used for the nasal tip, and an I-shaped implant was used for the nasal bridge

• 6 months later: During a revision procedure for nasal deviation, it was unexpectedly replaced with an L-shaped silicone implant

1. Front view

• Upturned nose

• Crooked nose

• Narrow nasal bridge

2. Profile view

• High radix

• Acute nasolabial angle

• Drooping nasal tip appearance

3. Nostrils

• Nostril asymmetry

• Columella deviated to the right

• Correction of upturned nose

• Creating a straight bridge line

• Lowering the radix

• Improvement of the nasolabial angle

• Improvement of nostril asymmetry

1. Reconstruction with a stable structure

• Removal of the L-shaped silicone implant

• Reconstruction of the nasal tip using only autologous rib cartilage with safety in mind

• Nasal bridge changed to an I-shaped implant

Removed L-shaped implant

2. Structural improvement

• Naturally lowering the radix

• Correction of upturned nose

• Correcting the columella tilted to the right

3. Shape improvement

• Creating a straight bridge line

• Correction of the nasolabial angle

• Improvement of nostril asymmetry

1. Front view

• Radix lowered to create a natural appearance between the eyebrows

• Significant nostril asymmetry and nostril show improved

• Crooked areas improved

2. Profile view

• Natural radix position

• Improvement of upturned nose

• Natural nasolabial angle

• Straight bridge line

3. Nostrils

• Improvement in nostril symmetry

• Correction of the tilted columella

• Softened nasal tip appearance

This case clearly illustrates the importance of material selection in rhinoplasty. In the patient's primary surgery 10 years ago, a structurally stable technique was used: septal and ear cartilage for the nasal tip, and an I-shaped implant for the nasal bridge. However, during a subsequent revision to correct deviation, the cartilaginous support structure of the nasal tip had inexplicably been replaced with an L-shaped silicone implant.

In rhinoplasty, the nasal tip requires the most delicate approach, and using cartilage is generally natural and stable. In particular, replacing a nasal tip that was already well-supported by cartilage with an L-shaped silicone implant departs from sound rhinoplasty principles. Because an L-shaped silicone implant extends in a single piece into the nasal tip, long-term use carries a relatively high risk of foreign body sensation, show-through, and structural deformation.

In this surgery, we focused on removing the L-shaped silicone implant, reconstructing the nasal tip using only autologous rib cartilage, and switching the nasal bridge to a reliable I-shaped implant. At the same time, we lowered the radix, corrected the nasolabial angle, and addressed the nostril asymmetry and right-tilted columella.

This case reaffirms that selecting the appropriate materials and surgical methods tailored to each patient is a vital factor in achieving long-term stability and satisfaction in rhinoplasty.

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

Thank you.

#closedrhinoplasty #revisionrhinoplasty #Lshapedimplant #Ishapedimplant #customrhinoplasty