Why the nasal tip gets pinched and the columella retracts: how Medpor removal and reconstruction are performed

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient whose pinched nose and unexpectedly discovered Medpor after repeated surgeries were resolved using autologous rib cartilage.

• 15 years ago: silicone implant + ear cartilage surgery

• 7 years ago: silicone implant + ear cartilage surgery

• 5 years ago: silicone implant + ear cartilage surgery (unclear whether septal cartilage was used)

1. Front view

• Pinched nasal tip shape

• Short columella

• Depressed nasal tip, alae appearing heavily lowered

• Flat appearance of the nasal bridge

2. Profile view

• High radix

• Blunt nasal tip

• Retracted, non-visible columella

3. Function

• Nasal obstruction

• Rhinitis symptoms

Deviated septum and hypertrophic rhinitis confirmed via nasal endoscopy

• Slender nasal shape

• Correction of the pinched areas (top priority)

• Desire to lower the columella so it becomes visible

• Nasal shape that does not look overly long

1. Unexpected findings

• Medpor identified in the columella and removed

• Removal of contracted scar tissue in the nasal tip

• Confirmed that almost no lower lateral (alar) cartilage remained

2. Structural reconstruction

• Lower lateral cartilage reconstruction using autologous rib cartilage

• Septal reconstruction using autologous rib cartilage for the excessively harvested septum

3. Shape improvement

• Lowering the radix

• Improvement of the pinched nose

• Lowering the short columella

• Correction of the nasolabial angle

• Correction of nostril shape

1. Front view

• Significant improvement in the pinched alar areas

• Nasal tip and columella lowered naturally

• Broad, spread nasal bridge refined

2. Profile view

• Radix starting point lowered

• Drooping nasal tip appearance improved

• Columellar line became natural

• Harmonious overall proportions

3. Nostrils

• Improved nostril asymmetry

• Nostril shape became much more natural

• Pinched areas along the alae significantly filled out

4. Function

• Deviated septal cartilage corrected

• Hypertrophic inferior turbinate significantly reduced in size, with expected relief of rhinitis symptoms

• Expected improvement in nasal obstruction

This was a complex case involving an unexpected intraoperative finding of Medpor and severe cartilage deficiency. In addition to contracted scar tissue found at the nasal tip, almost no alar cartilage remained, and the septal cartilage had been excessively harvested previously.

Using autologous rib cartilage, the deficient alar cartilages and septum were fully reconstructed, with particular focus on correcting the pinched nasal tip, which was the patient's primary concern. The short columella was lowered naturally, and overall proportions were balanced to achieve a slender nasal contour without making the nose appear long.

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

Thank you.

#closedrhinoplasty #revisionrhinoplasty #medporremoval #pinchednosecorrection #customrhinoplasty