Why implants show through and nostrils look M-shaped, and how to reconstruct them

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who visited our clinic concerned about implant show-through, a drooping tip, and an unnatural nostril appearance from the front.

• Approximately 25 years ago: silicone implant placement

• 2 years ago: silicone implant reinsertion

After two surgeries, issues arose where the implant shifted and the nose became crooked and deviated. In particular, the implant extended deeply into the nasal tip, making the tip skin significantly thin, with show-through so severe that there was concern the implant might break through.

• Improvement of drooping tip

• Resolving implant show-through and securely reinforcing the nasal tip

• Correcting the crooked nasal axis

• Improving the unnatural nostril shape (dragon nose) seen from the front

• Correcting the overall nasal contour naturally and safely

The patient lives overseas and had been concerned about the shape of the nose for a long time.

1. Nasal tip reinforcement and skin protection

Because the implant had been placed all the way to the tip, the thinned skin was reinforced with donor dermis to secure tip stability and support.

2. Foreign body removal

Foreign substances injected into the alae and glabella were meticulously removed, and the uneven surface of the nasal bridge caused by the foreign substances was smoothed out.

3. Dragon nose correction (improving the M-shaped nostrils)

Through lower lateral cartilage repositioning and cartilage grafting, the unnatural nostril shape seen from the front was corrected.

4. Nasal tip reconstruction using autologous rib cartilage

The nasal tip was elevated and projected using autologous rib cartilage to form a natural line, and the profile silhouette was improved by correcting the nasolabial angle.

5. Correction of nasal bone asymmetry

Lateral osteotomy was performed to straighten the deviated nasal bridge, and the silicone implant was precisely sculpted to fit the nasal bones, creating a smooth bridge line.

Front view changes:

• The unnatural M-shaped nostril appearance was naturally improved

• The previously crooked nasal axis was straightened

• Implant show-through was resolved, resulting in a stable nasal tip

Profile view changes:

• The drooping tip was elevated and well-projected

• The nasolabial angle was appropriately corrected, completing a refined profile

• Previously irregular nasal bridge line smoothly refined

Changes in nostril shape

• A balanced nostril shape was achieved through lower lateral cartilage repositioning

• Improvement of asymmetry

In revision rhinoplasty after multiple prior procedures, comprehensively evaluating the existing tissue condition, skin thickness, and the presence of foreign substances is of utmost importance. In this type of case, where the implant was inserted all the way to the tip and the skin had become extremely thin, skin reinforcement using donor dermis was key.

In addition, the previously injected foreign substances adhered to the surrounding tissues, requiring meticulous dissection, while the nostril deformity known as a dragon nose was corrected through cartilage repositioning and reinforcement. Reconstructing the nasal tip using autologous rib cartilage is an approach that supports a stable long-term result.

In revision rhinoplasty, accurately understanding the tissue changes caused by previous surgeries and tailoring the approach to the patient's individual condition are essential. I hope this helps those who share similar concerns.

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

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