Why the nasal tip shows through after dermal graft surgery and how to reconstruct it with autologous rib cartilage

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who underwent autologous rib cartilage reconstruction combined with stem cell therapy to resolve nasal tip show-through caused by donor dermis and improve midface length.

12 years ago

• Nasal filler injection → dissolved

7 years ago

• Silicone implant + ear cartilage + autologous rib cartilage

2 years ago

• Autologous rib cartilage + ear cartilage + donor dermis + alar reduction + nostril elongation

Patient information

• Allergies: Psoriasis allergy, hyaluronidase allergy

Primary concerns

• Nasal tip show-through (caused by donor dermis)

• Long-appearing midface

• Current nose lacks definition and projection

• Unnatural appearance from donor dermis on the nasal dorsum

Issues related to donor dermis

• Thinning and show-through at the nasal tip caused by donor dermis on the dorsum

• Unnatural surface contour of the nose

• Concerns regarding long-term stability

Special notes

• Special precautions required during surgery due to psoriasis and hyaluronidase allergies

• Tissue changes from multiple previous surgeries

• High expectations for a well-defined result

• Complete resolution of nasal tip show-through

• To make the midface appear shorter

• Achieving a well-defined nasal profile

• Natural yet distinct result

Complete removal of donor dermis

• Complete removal of donor dermis used on the nasal dorsum

• Resolving the root cause of nasal tip show-through

• Establishing a clean surgical field

Structural reconstruction

• Full reconstruction using autologous rib cartilage

• Securing adequate tissue thickness to prevent nasal tip show-through

• Achieving a well-defined yet natural nasal line

Midface improvement

• Visually shortening the midface through nasolabial angle correction

• Improving facial proportions by elevating the nasal tip

• Enhancing overall facial balance

Specialized treatment - stem cell therapy

• 3 postoperative stem cell therapy sessions administered

• Promoting regeneration of damaged tissue

• Accelerating recovery speed and optimizing results

Surgery planned with allergy considerations

• Selection of surgical materials considering psoriasis allergy

• Surgical planning considering hyaluronidase allergy

• Application of a specialized postoperative care protocol

Complete resolution of nasal tip show-through

• Complete resolution of tip thinning and transparency by removing donor dermis

• Restoration of natural nasal tip thickness

• Healthy and natural tip shape

Front view

• Prominent, refined nasal contour

• Natural nasal tip shape

• Improved surface contour following donor dermis removal

• Balanced overall facial proportions

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

Profile view

• Refined and well-defined nasal profile

• Effect of a visually shorter midface

• Natural nasolabial angle

• Balanced overall facial profile

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

Midface improvement

• Visual midface shortening effect through nasolabial angle correction

• Overall facial proportion improvement via tip elevation

• Refined and balanced facial appearance

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

Outcomes of specialized care

• Safe recovery with psoriasis allergy accounted for

• Surgery completed without hyaluronidase allergy complications

• Tailored postoperative care based on individual medical characteristics

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

Effects of stem cell therapy

• Faster recovery rate

• Stimulation of tissue regeneration

• Optimized surgical outcome

• Securing long-term stability

This case involved a patient who wanted to resolve nasal tip show-through caused by donor dermis used in a previous surgery, while also shortening the visual appearance of the midface. Because the patient had two specific allergies—psoriasis and hyaluronidase—special care was necessary when formulating the surgical plan and selecting materials.

The patient's primary concern was show-through at the nasal tip. Donor dermis placed on the nasal dorsum during a prior surgery had, over time, created a visible, translucent show-through at the tip. Although donor dermis may appear natural initially, its borders can become more apparent from surrounding tissues over time, resulting in an unnatural appearance.

To resolve this, completely removing the donor dermis and replacing it with autologous tissue was essential. By reconstructing with autologous rib cartilage, adequate thickness could be restored at the nasal tip while preventing future show-through.

The visual midface shortening desired by the patient was achieved by adjusting the nasolabial angle. Elevating the nasal tip appropriately and refining the nasolabial angle visually shortened the midface. At the same time, we achieved the defined nasal line the patient preferred.

Given the patient's psoriasis and hyaluronidase allergies, material selection and recovery management were critical. All surgical materials and medications were chosen with caution, and a specialized pre- and postoperative management protocol was applied.

Combining stem cell therapy was another key element of this case. It assisted in stimulating regeneration in the tissue damaged by donor dermis, accelerated the overall recovery process, and supported an optimized final outcome.

We also planned the timing of the surgery around the patient's preference to avoid hot weather. This careful scheduling aimed to minimize discomfort throughout recovery and support favorable healing conditions.

As a result, the nasal tip show-through was completely resolved, and we achieved both the defined, natural nose and the midface shortening effect the patient wanted. Furthermore, because tissue regeneration was stimulated through stem cell therapy, a stable long-term result can be expected.

This case highlights how customized surgical planning that accounts for individual allergy profiles and cosmetic goals can produce a successful outcome.

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

Thank you.

#closedrhinoplasty #revisionrhinoplasty #autologousribcartilage #donordermisremoval #tipshowthroughcorrection #midfaceshortening #stemcelltherapy #customrhinoplasty