Why mesh remaining in the septum causes an upturned nose, and reconstruction after removal

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce a revision rhinoplasty case of a patient who visited our clinic seeking to correct an upturned nasal appearance and noticeable nostril show from the front view.

This is a revision case where the patient had their first rhinoplasty about 10 years ago and subsequently underwent two additional procedures.

• First surgery: silicone implant insertion, ear cartilage graft, dorsal hump reduction, osteotomy

• Second surgery: revision rhinoplasty

• Third surgery: implant replacement, ear cartilage graft, tip dermis reinforcement (at another clinic)

• Afterward, periodic Rejuran injections were administered to the nasal tip

• Correction of an upturned nose with excessive nostril show from the front view

• Improvement of tip depression (sunken appearance)

• Concern over whether surgery was possible due to thinned tip skin

• Desire for a natural correction focused on addressing shortcomings rather than increasing height

During surgery, foreign material (mesh) used in a previous surgery was discovered in the septum and was completely removed. It was determined that this mesh material had shortened the septum, causing the nose to turn upward.

1. Complete removal of foreign material (mesh): All mesh discovered in the septum was safely removed.

2. Septal reconstruction using autologous rib cartilage: After removal, the damaged septum was reconstructed using the patient's own rib cartilage.

3. Nasolabial angle correction: The angle of the upturned nose (the angle between the nose and the upper lip) was naturally improved.

4. Silicone implant replacement: The existing implant was removed, and a new silicone implant was placed only along the nasal dorsum.

5. Tip skin reinforcement using acellular dermal matrix: Acellular dermal matrix was applied to reinforce the thinned tip skin.

6. Septoplasty and turbinate reduction: Surgery to improve nasal function was performed concurrently.

Front view changes

• The previously upturned nasal shape was naturally corrected.

• The nostrils, which were excessively visible from the front view, were noticeably reduced.

Profile view changes

• The nasolabial angle was appropriately adjusted, improving the profile line.

• The nasal dorsum maintained a natural height with the new implant.

Changes in the nasal tip

• With dermal reinforcement, a natural shape was achieved without tip depression.

The most critical part of this case was the complete removal of the foreign material discovered during surgery.

The mesh material found in the septum had shortened it, serving as the main cause of the upturned nose. After removing all of the mesh, reconstructing the septum with autologous rib cartilage restored a stable structural foundation.

In addition, when undergoing multiple surgeries, the tip skin tends to become thin; reinforcing the skin with acellular dermal matrix helps prevent implant visibility and skin damage. Functional nasal surgery was also performed at the same time to address both appearance and function.

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

#closedrhinoplasty #closedrevisionrhinoplasty #revisionrhinoplasty #autologousribcartilage #septalreconstruction #foreignbodyremoval #upturnednosecorrection #nostrilcorrection #acellulardermalmatrix #turbinatesurgery