Why nasal tip skin thins and cartilage shows through, and how skin reinforcement is done

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who previously underwent a 1st revision for a contracted nose at our clinic and later underwent revision rhinoplasty due to concerns about deformities caused by thinning skin.

About 5 years ago: Prior surgery with silicone implant + ear cartilage, functional nasal surgery

• Stiffness developed after ear cartilage was used in the nasal tip

• Contracture deformity developed as the skin gradually thinned

2 years ago: Contracted nose surgery performed at our clinic using autologous rib cartilage

• The retracted columella was corrected, but as the tip skin thinned, the grafted cartilage began to show through and the nose appeared upturned. Nasal obstruction improved somewhat, but discomfort persisted

• "I want to correct my upturned nose naturally"

• "I want to balance the nostril asymmetry as much as possible"

• "I want to add soft volume to my nasal tip"

• "I am worried about my thinned skin"

• "I want to prevent the tip cartilage from showing through"

• "I want the surgery to be performed with safety in mind"

In this surgery, the key was a safe approach to address the deformities caused by thinning skin and to prevent recurrence.

1. Existing implant removal and tissue evaluation

• Removal of the silicone implant from previous surgery

• Assessment and repositioning of the ear cartilage

• Precise evaluation of thinned skin thickness

• Formulation of a safe reconstructive plan

2. Safe height adjustment

• Slight adjustment of height to reduce skin tension

• Subtle changes that are barely noticeable to the patient

• Finding an optimal balance point to prevent recurrence

• A stable structure that does not strain the skin

3. Skin reinforcement using dermis

• Reinforcement of thinned bridge skin with dermis

• Simultaneous reinforcement of columella skin

• Ensuring stability by increasing skin thickness

• Preserving a natural feel to the touch

4. Double-layer reinforcement with autologous rib perichondrium

• Minimizing the chance of tip cartilage show-through

• Harvesting perichondrium alongside autologous rib cartilage

• Layering the perichondrium in two folds for reinforcement

• Creating soft volume at the nasal tip

Autologous rib cartilage (perichondrium) - skin reinforcement

5. Correction of upturned nose

• Septal extension using autologous rib cartilage

• Natural repositioning of the nasal tip

• Creating an appropriate nasolabial angle

• Achieving an elegant profile line

6. Improvement of nostril asymmetry

• Balancing the size of both nostrils

• Alignment of the columellar midline

• Natural nostril shape

• Achieving overall symmetry

Front view changes:

• Natural correction of the upturned nose

• Balanced correction of nostril asymmetry

• Previously thinned skin now looks healthy

• Improvement in overall facial balance

• Natural line from the front view

Profile view changes:

• The upturned nasal tip was lowered naturally

• An elegant line with an appropriate nasolabial angle

• Creating soft volume at the nasal tip

• A stable appearance achieved through skin reinforcement

• A refined and natural profile silhouette

Nostril view changes:

• Nostril asymmetry improved as much as possible

• Alignment of the columellar midline

• Achieving bilateral balance

• Natural nostril shape

• Improving overall symmetry

One of the most challenging scenarios in revision rhinoplasty is deformity caused by thinning skin. Over time after previous surgery, the skin may gradually thin out, which can cause the tip cartilage to show through or lead to deformities.

In such cases, it is crucial not only to resolve the deformities caused by thinned skin, but also to prevent the same problem from recurring. Merely correcting the visible deformity is not enough; addressing the underlying cause is essential to maintain long-term, stable results.

The most pivotal approach was reducing skin tension. While I was concerned the patient might feel disappointed if the height was lowered, we maintained as much height as possible within a safe range that placed no strain on the skin. Ultimately, the patient could barely perceive any change in height and was pleased with the more natural and stable appearance.

Skin reinforcement using dermis was a critical step. The thinned skin over the bridge and columella was reinforced with dermis to increase skin thickness. This does not simply add volume; it improves skin strength to provide long-term stability.

To minimize the possibility of tip cartilage show-through, perichondrium harvested from autologous rib cartilage was layered double for reinforcement. Perichondrium is very soft yet effective for reinforcement, serving exceptionally well to add natural volume to the nasal tip while preventing cartilage visibility.

Correction of the upturned nose and improvement of nostril asymmetry were carried out concurrently. Septal extension was utilized to bring the nasal tip down naturally, balancing both nostrils to achieve overall symmetry. Only when all of these steps harmonize can a natural and aesthetically pleasing result be achieved.

Revision surgery requires much more detailed and cautious planning than primary rhinoplasty. When the skin has thinned, an especially careful approach is needed to find fundamental solutions that prevent recurrence.

I will continue to provide customized surgeries that reflect each patient's individuality and requests through this meticulous approach. I hope this helps those with similar concerns.

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

#upturnednosecorrection #nostrilasymmetry #thinskincorrection #dermisgraft #autologousribcartilage #perichondriumreinforcement #revisionrhinoplasty #naturalnasaltip #softnasaltip #skintension #saferhinoplasty #tipcartilage #columellareinforcement #closedrhinoplasty #closedrevisionrhinoplasty