Changes that occur when an implant is positioned high and deviated: methods for replacement and bulbous tip correction

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce a revision rhinoplasty case of a patient who was unsatisfied with their nasal shape despite having undergone multiple procedures.

• About 10 years ago: Filler injection to the nasal bridge and nasal tip

• About 3 years ago: Rhinoplasty using a silicone implant, ear cartilage, and septal cartilage (filler removal performed concurrently)

• About 2 years ago: Revision surgery at the same clinic

Despite having a total of three procedures and surgeries, the patient remained dissatisfied with the nasal shape and visited NOSELAB.

• Wants to refine a blunt, wide nasal tip into a sharper appearance

• Wants to lower the radix so that the nose does not appear long

• Desires a natural yet defined straight bridge line

1. Implant replacement and radix correction

The existing silicone implant was positioned very high and deviated to the right. It was removed and replaced with a newly carved silicone implant tailored to the nasal bone structure, naturally lowering the radix and correcting the crooked nose.

2. Septal extension using donor rib cartilage

To secure structural support for the nasal tip, septal extension was performed using donor rib cartilage.

3. Bulbous tip correction

Partial resection of subcutaneous soft tissue at the nasal tip and lower lateral cartilage suturing were performed to gather the blunt, wide tip. Increasing the tip projection added three-dimensional definition to improve the bulbous tip.

4. Nasolabial angle correction and columella shaping

The retracted columella was lowered using donor rib cartilage along with previously harvested septal cartilage and ear cartilage, creating a natural nasolabial angle. This also reduced the elongated appearance of the nose.

5. Concurrent rhinitis surgery

Because the patient reported nasal obstruction, inferior turbinate reduction was performed concurrently to achieve functional improvement.

Front view changes: The blunt, spreading nasal tip has been gathered and refined. The nasal bridge that had deviated to the right is now properly aligned.

Profile view changes: The previously high radix was naturally lowered, eliminating the impression of an overly long nose. A natural yet defined straight bridge line was established. With appropriate correction of the nasolabial angle, a refined profile silhouette was achieved.

Nostril view changes: The retracted columella was naturally brought down, improving nostril balance.

In revision rhinoplasty involving multiple past procedures, accurately evaluating the existing materials and tissue status is of paramount importance. In cases like this, after comprehensively evaluating the malpositioned implant and weakened tip structural support, implant replacement was performed alongside structural reinforcement using donor rib cartilage.

In particular, adjusting both the radix and the nasolabial angle corrected the elongated appearance of the nose, and correcting the bulbous tip achieved the refined, elegant nasal line the patient desired. Addressing functional concerns with concurrent rhinitis surgery was also a key aspect of this procedure.

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

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