Why nasal tip skin depresses and implants show through after inflammation, and how to reconstruct it

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who visited our clinic concerned about depressed nasal tip skin and nasal bridge implant show-through after undergoing multiple revision rhinoplasties.

• Approximately 10 years ago: Rhinoplasty using silicone and artificial dermis, along with septal surgery, at another clinic

• Postoperative inflammation occurred, causing nasal tip swelling and drainage of pus (no separate anti-inflammatory treatment was performed)

• Interim period: Revision surgery to remove the previous implant and overlay dermal tissue only

• Approximately 5 years ago: Revision rhinoplasty using ear cartilage and a silicone implant

• Recently: Additional revision surgery using dermal tissue alone

• Improve the nasal tip skin depression resulting from previous surgical complications

• Resolve the nasal bridge implant show-through

• Stabilize the nasal structure weakened by repeated revisions

• Restore a natural yet well-defined nasal line

• Simultaneously improve functional issues such as nasal obstruction

1. Management of damaged nasal tip skin

The depressed portion of the nasal tip skin, which had undergone partial necrosis from previous surgery, was meticulously excised and sutured to blend naturally with the surrounding healthy tissue.

2. Restoration of the depressed area

Skin thickness was secured through a dermal graft, and an additional cartilage graft restored three-dimensional volume to the depressed area simultaneously.

3. Nasal tip plasty using autologous rib cartilage

Using cartilage harvested from the patient's rib, I created a natural tip shape that is elevated yet softly rounded.

4. Septal cartilage reconstruction

The septal structure, weakened by repeated surgeries, was reinforced with autologous rib cartilage to secure long-term stability for the nasal tip.

5. Nasal bridge shaping with a new implant

The existing implant causing show-through was removed, and a new silicone implant was hand-carved to match the contour of the patient's nasal bone, achieving a natural and stable nasal bridge line.

Front view changes

• Depressed nasal tip skin is restored

• Area with implant show-through is naturally improved

• A well-defined, balanced nasal line is achieved

Profile view changes

• Low, unstable nasal bridge is elevated into a refined line

• Drooping nasal tip is naturally lifted

• Nasolabial angle is refined, creating a more sophisticated profile

Changes in nostril shape

• Asymmetrical nostril shape is balanced

• Nostrils settle stably with a cohesive tip shape

In patients who have undergone multiple revisions and bouts of inflammation, nasal tissue is often weaker and more damaged than in a primary case. In particular, when skin depression occurs due to nasal tip necrosis, a reconstructive approach that restores the damaged tissue itself is essential, going beyond merely reshaping the nose.

In this surgery, the primary focus was to restore both thickness and three-dimensional contour to the depressed area by combining dermal and cartilage grafts. Furthermore, septal reconstruction using autologous rib cartilage is not just about shaping the nasal tip; it is a critical step that prevents the tip from drooping and maintains long-term structural stability.

It is also crucial to hand-carve the bridge implant to match the curvature of the patient's nasal bone. Using an off-the-shelf implant as-is can cause show-through or an unnatural appearance, so fine adjustments tailored to each patient's individual anatomy determine how natural the outcome looks.

Each revision rhinoplasty is like a fresh start. Accurately assessing the remnants of previous procedures and the tissue condition, and then designing an individualized approach accordingly, is of utmost importance. I hope this case helps those facing similar concerns.

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

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