Why nasal tip cartilage shows through the skin and how dermis grafting reinforces it

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce the case of a patient who visited our clinic concerned about cartilage show-through at the nasal tip and a widened nose following previous surgery.

7 years ago: silicone implant, ear cartilage, septum, alar reduction

• Although overall rhinoplasty had been performed

• Over time, the nasal tip cartilage began to show through the skin

• The nose also began to appear wide and crooked

The patient had concerns about the following issues after a previous surgery:

1. Nasal tip cartilage show-through: cartilage visible through the nasal tip skin

2. Distinct contour: wanting a clearly defined nasal contour from the front view

3. Slim, defined tip: a refined, sharper nasal tip

4. Straight line: a bridge line closer to straight than a straight-to-slightly-curved line

5. Correcting a wide nose: correcting widened nasal bones

6. Correcting a crooked nose: securing symmetry for a slightly deviated nose

7. Improving nasal obstruction: breathing difficulties caused by a deviated septum and hypertrophic rhinitis

In this patient's case, cartilage show-through from the previous surgery was the primary aesthetic concern. In addition, nasal obstruction caused by a deviated septum and hypertrophic rhinitis needed to be addressed.

1. Skin reinforcement using autologous dermis

• Autologous dermis grafting over the area of nasal tip cartilage show-through

• Reinforcing skin thickness to prevent cartilage from showing through

• Maintaining natural skin texture

• Establishing stable, long-term skin thickness

2. Widening the nasal tip cartilage width

• Broadening and repositioning the previously used cartilage

• Structurally preventing recurrent cartilage show-through

• Securing both tip volume and structural stability

• Creating a defined yet natural nasal tip shape

3. Nasal tip plasty using autologous rib cartilage

• Precise sculpting for a slim, defined tip

• Forming a sharp, refined nasal tip line

• Achieving a bridge line close to straight

• Emphasizing a distinct contour on the front view

4. Lateral nasal osteotomy

• Accurately correcting deviated nasal bones

• Narrowing widened nasal bones for a slimmer impression

• Achieving bilateral symmetry

• Balanced proportions on the front view

5. Septoplasty

• Correction of deviated septum

• Restoring internal nasal cavity symmetry

• Improvement of breathing function

6. High-frequency radiofrequency turbinoplasty

• Reducing inferior turbinates enlarged by hypertrophic rhinitis

• Securing internal nasal airway space

• Addressing the root cause of nasal obstruction

• Rapid recovery through a minimally invasive approach

7. Nasolabial angle correction

• Improving the angle between the nose and the upper lip

• A refined silhouette in the profile line

• Harmony in overall facial proportions

1. Resolution of nasal tip cartilage show-through

• Skin thickness reinforced with autologous dermis grafting

• Cartilage completely covered for a natural nasal tip

• Widened cartilage width prevents recurrence

• Smooth skin texture maintained

2. Aesthetic improvement

• Defined nasal contour on the front view

• Slim, defined nasal tip with a sharp aesthetic

• Refined bridge line close to straight

• Better symmetry achieved by correcting deviated nasal bones

• A previously wide nose transformed into a slim, refined appearance

3. Functional improvement

• Structural stability achieved through deviated septum correction

• Securing internal nasal airway space with turbinoplasty

• Smooth breathing through both sides

• Chronic nasal obstruction significantly improved

4. Overall harmony

• Refining the profile line through nasolabial angle correction

• Balanced proportions so the midface does not appear elongated

• Proportions in harmony with the whole face

Cartilage show-through at the nasal tip occurs when the skin is thin or when the cartilage framework is overly sharp. In this patient's case, the cartilage used in the previous surgery was relatively sharp, and because the skin was thin, the cartilage gradually became more visible over time.

Resolving this problem requires a two-step approach. First, skin thickness must be reinforced. Because autologous dermis is harvested from the patient's own body, there is no risk of rejection, and it remains stable over time, making it an ideal material for reinforcing nasal tip skin.

Second, the cartilage structure itself must be modified. Rather than merely thickening the skin, the cartilage width was widened and repositioned so that sharp edges no longer irritate the skin. This not only resolves the current issue but also prevents future cartilage show-through.

At the same time, autologous rib cartilage was sculpted to create the slim, defined nasal tip desired by the patient. Achieving a sharp definition without allowing cartilage to show through requires a delicate balance; performing both skin reinforcement and cartilage repositioning enabled us to satisfy both goals.

Additionally, lateral nasal osteotomy corrected the widened and deviated nasal bones, creating a clear and slim contour from the front view. Nasal obstruction caused by a deviated septum and hypertrophic rhinitis was also addressed, yielding a result that was satisfying both functionally and aesthetically.

Revision rhinoplasty should not simply correct the problem area; it is essential to understand and treat the underlying cause. NOSELAB will continue to pursue systematic analysis and delicate surgical techniques to achieve the intended results for our patients.

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

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