Foreign materials from illegal procedures in the nasal bridge: how to perform removal and total septal reconstruction

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce a very complex and demanding revision rhinoplasty case. This is the story of a patient who required both nasal bridge foreign material removal and a complete reconstruction of the septum from scratch.

Past surgical history:

• 9 years ago: Surgery using a silicone implant and septal cartilage

• 4 to 5 years ago: Revision rhinoplasty

• In between: Illegal injection procedure on the nasal bridge

The patient had the following concerns:

• Discomfort and anxiety caused by the foreign material in the nasal bridge

• An unnatural nasal shape

• Skin tension and tightness caused by contracture

• A desire for a structurally stable, improved overall nasal appearance

This type of case involves highly complex revision surgery, requiring a careful step-by-step approach.

Step 1: Complete foreign material removal

We completely removed the illegal substance injected into the nasal bridge. Because such materials can cause serious problems over time, including inflammation, deformity, and migration, removal is essential.

Step 2: Assessing the condition of the septum

Due to the two previous surgeries, almost no septal cartilage remained. This meant that the central support structure of the nose was absent, requiring total reconstruction.

Step 3: Total septal reconstruction using autologous rib cartilage

To rebuild the septum from the foundation up, we harvested and used the patient's own rib cartilage. This method provides the most stable and strong support framework.

Step 4: Addressing skin issues

• Severely thinned skin: The skin had become very thin due to previous surgeries

• Severe contracture: The skin was distorted and adhered

• Dermal reinforcement: Dermis was grafted to reinforce the thinned skin

• Release of adhesions: Meticulous dissection to free adhesions in indented areas

Step 5: Structural reconstruction

Septal extension: Providing nasal tip support using the newly reconstructed septum

Reconstruction of the lower lateral cartilages: Establishing a stable nasal tip framework

Conservative approach: Prioritizing stability while defining appropriate height and shape

Frontal changes:

• Formation of a natural bridge line

• A stable nasal tip shape

• A balanced overall profile

Profile changes:

• A smooth nasal bridge line

• An appropriate nasal tip angle

• Natural nasolabial angle

Nostril changes:

• Symmetric nostril shape

• A stable columella line

• A well-balanced nasal tip structure

Cases of this nature represent highly demanding revision rhinoplasty in many respects.

The greatest challenges:

1. Removal of illegal foreign materials

Substances from unauthorized injections in the nasal bridge must be removed. If left untreated, they can lead to severe complications such as inflammation, skin necrosis, and nasal deformity. Complete removal was the top priority.

2. Depletion of septal cartilage

After two previous surgeries, almost no septal cartilage remained. The septum acts like the central pillar of the nose; losing it is like having a house without its central support pillar. Therefore, it had to be rebuilt from scratch using autologous rib cartilage.

3. Extremely thin and compromised skin

Due to repeated operations and foreign material injections, the skin was very thin and severely contracted. In such cases, one must respect the limits of what the skin envelope can tolerate, as attempting excessive height can cause greater complications.

4. The importance of a staged approach

In this surgery, we prioritized stability and took a conservative approach. Allowing the newly reconstructed septum and supporting structures to heal securely is paramount.

If the patient desires a higher profile in the future, further refinements can be considered after 6 months once the reconstructed tissues have completely stabilized. This strategy is far safer and yields better results than attempting an overly aggressive single operation.

The dangers of illegal cosmetic procedures:

Through cases like this, I want to emphasize once again the serious risks of illegal procedures. Unauthorized injections and illegal fillers may not seem problematic initially, but complications inevitably arise over time.

• Inflammation and infection

• Migration and deformation of the foreign substance

• Skin damage and necrosis

• Considerations during removal surgery

Procedures should only be performed at officially licensed medical institutions using materials approved by the Ministry of Food and Drug Safety.

A systematic approach is the answer for complex revision rhinoplasty:

1. Accurate diagnosis: Understanding the precise current condition

2. Setting priorities: Determining what to resolve first

3. Safety first: Placing structural stability ahead of pure aesthetics

4. A staged approach: Dividing treatment into stages when necessary

5. Adequate recovery period: Allowing sufficient time for tissues to stabilize

I will continue to address my patients' concerns with this systematic approach planned with safety in mind. I hope this helps those with similar concerns. This was Dr. Peter C. Kang, Medical Director. Thank you.

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