Why nasal tip skin thins after multiple surgeries: autologous dermis reinforcement and reconstruction methods

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce a revision rhinoplasty case of a patient who had undergone multiple nasal surgeries but was dissatisfied with the height of the nasal bridge and nasal tip.

About 14 years ago, the patient received nasal filler injections and later had them dissolved. About 7 years ago, rhinoplasty was performed using autologous rib cartilage and a silicone implant. Then, about 1 year ago, only the nasal tip was revised using ear cartilage and Alloderm, along with alar rim graft surgery (nostril lowering). However, the patient remained dissatisfied with the result of the nasal tip and visited NOSELAB.

• Desire for overall greater height along the nasal bridge

• Desire to elevate the nasal tip height as well

• Improvement of nostril asymmetry

• Refining the nasal profile by correcting the nasolabial angle

• A refined yet natural-looking nose

1. Correcting nasal tip height using autologous rib cartilage

The ear cartilage and Alloderm from the previous surgery were removed, and the support structure of the nasal tip was newly reconstructed using autologous rib cartilage to achieve the desired height.

2. Reinforcing the nasal tip skin using autologous dermis

Because the nasal tip skin had become thin after multiple surgeries, autologous dermis was used to reinforce the skin and protect against implant show-through.

3. Correcting nasal bridge height through recarving the silicone implant

After removing the existing silicone implant, a new implant was carved to match the patient's nasal bone shape, naturally elevating the nasal dorsum.

4. Correcting the step-off at the glabella using autologous fat grafting

Because of prominent brow bones, there was a visible step-off transition from the glabella to the nasal bridge. Autologous fat grafting was performed to create a smooth, continuous line from the forehead down to the nasal bridge.

5. Nasolabial angle correction

By adjusting the angle between the nasal tip and the upper lip on profile view, a refined lateral profile was achieved.

Front view changes

• The nasal bridge is raised overall, creating a clear and defined nasal contour

• Nostril asymmetry is improved, producing a balanced appearance

• The nasal tip is elevated and well-defined, providing a sophisticated look

Profile view changes

• A natural, continuous line from the forehead to the nasal bridge is achieved

• The step-off between the eyebrows is resolved, creating a smooth profile silhouette

• The nasolabial angle is appropriately corrected, resulting in a refined yet natural nasal line

Overall change in impression

• The nasal bridge and nasal tip are raised in harmony, enhancing overall facial three-dimensionality

• A distinct yet natural-looking result without looking overdone

When a patient has undergone multiple nasal surgeries, accurately assessing the previously used materials and the condition of the tissues is paramount. In particular, when the nasal tip skin has thinned, implants can become visible; reinforcing the skin with autologous dermis is therefore essential for a stable outcome.

In this type of case, structural support for the nasal tip was secured using autologous rib cartilage, and the silicone implant was recarved to conform to the nasal bone, creating a natural height along the bridge. In addition, the step-off caused by the brow bones was smoothly bridged using autologous fat grafting, completing a single, continuous line from the forehead to the nasal tip.

Revision rhinoplasty is more complex than primary rhinoplasty, but when approached with a thorough analysis of tissue conditions and the patient's aesthetic goals, satisfying results can certainly be achieved.

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

#revisionrhinoplasty #autologousribcartilagerhinoplasty #autologousdermisreinforcement #bridgeelevation #nasolabialanglecorrection #glabellafatgrafting #closedrhinoplasty #closedrevisionrhinoplasty