Contracted nose: How contracted tissue removal and autologous rib cartilage reconstruction are performed

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce a revision rhinoplasty case of a patient who visited our clinic after developing contracture following a previous surgery.

• 7 years ago: Rhinoplasty using a silicone implant and septal cartilage

As time passed after the previous surgery, contracture developed, leaving the patient with several concerns.

Main requests:

• Revision rhinoplasty planned with safety in mind using autologous rib cartilage

• Improvement of upturned nose

• Correction of crooked nose

• Lowering the columella to reduce nostril show

• Correction of the nasolabial angle

1. Removal of contracted tissue

The most crucial step in this surgery was the thorough removal of contracted tissue. Because the contracture had progressed substantially, the contracted skin and fibrotic tissue were meticulously removed.

Removed foreign material

Due to this process, swelling may be slightly more pronounced and the recovery period longer compared to other patients, but it is an essential step to prevent recurrent contracture and expand the contracted skin.

2. Nasal tip reconstruction using autologous rib cartilage

Autologous rib cartilage was harvested to reconstruct the nasal tip anew.

Advantages of autologous rib cartilage:

• No tissue rejection because it is autologous tissue

• Minimizing the risk of recurrent contracture

• Maintaining tip shape over the long term with strong structural support

• Effective for correcting an upturned nose and columellar position

3. Silicone implant replacement

For the nasal bridge, a new silicone implant was carved with precision to match the patient's nasal structure. While straightening the deviated nasal bridge, a natural line was created.

4. Correction of nasolabial angle

The columella was lowered to reduce nostril show, establishing a natural nasolabial angle when viewed from the profile.

Front view changes:

• The deviated nasal bridge was straightened

• Securing overall nasal symmetry

• Natural bridge line

Profile view changes:

• The upturned nasal tip was lowered naturally

• Refined profile line with an improved nasolabial angle

• Balanced nasal shape through columellar repositioning

Nostril view changes:

• Nostril show is reduced

• Stable shape achieved by lowering the columella

• Improvement of left-right symmetry

Revision rhinoplasty for a contracted nose requires a much more meticulous approach than standard revision rhinoplasty. Contracture is a phenomenon where the capsule around the implant thickens and contracts, altering the shape of the nose, and it cannot be resolved simply by replacing the implant.

In this type of case, we minimized the risk of recurrent contracture by thoroughly removing the contracted tissue and reconstructing the nasal tip with autologous rib cartilage. Although swelling may be temporarily more noticeable during the removal of contracted tissue, this is an essential step to sufficiently stretch the contracted skin and establish a healthy tissue environment.

Reconstruction using autologous tissue supports a stable long-term result, and the upturned nose and excessive nostril show that concerned the patient were also improved. This has been Dr. Peter C. Kang, Medical Director. Thank you.

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