Repeated "Factory-Style" Rhinoplasty and Its Dangerous Results: Can a 9th Revision Rhinoplasty Bring Hope Again?

1. February 2017: 1st surgery at Won-Suk Kook Plastic Surgery (4th surgery overall) 

PH

1st: 20 years earlier, nose surgery with silicone.

2nd: 3 years earlier, silicone removal + tip plasty with ear cartilage. 

→ Contracture later developed because of infection, and everything was removed.

3rd: 2 years earlier, revision surgery with costal cartilage. (The 1st, 2nd, and 3rd were all at other clinics.)

CC

The skin of the nasal tip was thin and under considerable tension.

The bridge was low and only the tip was conspicuously high, giving a "Pinocchio" tip.

The dorsum was wide and spread out.

OP

Removal of the costal cartilage from the tip and a columellar strut with ear cartilage.

→ Height adjustment and reduced skin tension.

Lowering of the tip with a derotation graft.

Narrowing of the dorsum with osteotomy.

Dorsal augmentation with acellular dermal matrix.

A

Removing the cap graft (autologous costal cartilage) that had been placed on the tip.

B

Beneath the cap graft, an extension graft used to lengthen the tip is visible.

All of it was autologous costal cartilage, and it was removed completely.

In addition, we placed a columellar strut of ear cartilage to raise the tip and, to lengthen the nose,

a derotation graft of ear cartilage, and performed osteotomy to narrow the dorsum and dorsal augmentation with acellular dermal matrix. 

After surgery, the cartilage show-through and the pointed appearance of the tip skin were corrected.

The low bridge was also raised naturally to match the height of the tip. 

The tip, pointed and translucent before surgery, became rounded and fuller.

The dorsum was also narrowed, and the patient was pleased.

The dorsal line, which was bent before surgery, became straight.

The tip, where cartilage showed through white and which was upturned, came down and became fuller.

The dorsal line, bent before surgery, was raised naturally and now flows smoothly into the tip.

The tip, which was pointed and tense, also became soft and natural.

Afterward, the patient became noticeably brighter and grew close to our clinic staff,

and, while receiving various minimally invasive treatments at our clinic, said, "I'm too afraid to go to any other clinic now."

The patient, who had said life would not be worth living if this surgery failed, fortunately looked at ease thanks to the good result,

and my own anxious heart was put at ease as well.

2. June 20, 2022: 2nd surgery at our clinic, 7th overall 

PH

After revision surgery at our clinic in February 2017, 

the patient wanted more nasal length and a higher bridge, and so went to another clinic and, with autologous costal cartilage and acellular dermal matrix,

underwent augmentation rhinoplasty twice; infection developed both times, and the acellular dermal matrix was removed. 

(January 2021: surgery with acellular dermal matrix & autologous costal cartilage →  infection developed. Removed 20 days later. Contracture developed after removal.

May 27, 2022:  augmentation with acellular dermal matrix alone →  infection again. The acellular dermal matrix was removed 5 days later. 

The inside of the nose was irrigated 2 times, but infection was still present.) 

CC

Infection still remained, contracture was severe, and the tip deformity was also severe.

PLAN

We decided to perform infection removal surgery first and then, after 1 year, reconstructive surgery with autologous costal cartilage. 

OP

Removal of infected tissue. (Removal of costal cartilage + septum + remaining ear cartilage + capsule + infected tissue)

The second surgery at our clinic alone and the 7th overall. Using an open approach, we removed all of the infected tissue.

Facing a 7th surgery brought on by the patient's own desire for more, the patient was very depressed

and struggling, but was too afraid to go to any other clinic and so, 

apologetically, had come back to ours, promising to follow our instructions faithfully from now on.

We decided to divide the removal surgery and the reconstructive surgery into two stages and performed the removal surgery first.

During surgery we found that a silicone capsule, which had been removed once before, along with costal cartilage, septal cartilage, ear cartilage,

and granulomas, remained inside the nose, and we removed them all thoroughly.

Afterward, skin contraction caused the columella to retract further and the nostrils to narrow, and the skin was stiff and uneven.

Then, to prepare for reconstructive surgery, the patient received autologous blood-derived stem cell injections 3 times, starting 1 month after surgery.

At 5 months after surgery, after 3 sessions of autologous blood-derived stem cell treatment following removal,

the contraction had eased and the tissue was somewhat softer than at 1 month, as the photos show.

However, the condition was still not suitable for reconstructive surgery.

The granulomas that clung to the columella as small bead-like lumps before the removal surgery

were cleanly removed after surgery, and the swelling also subsided markedly.

At 1 month after the removal surgery, the skin and cartilage of the nasal tip had shrunk from contracture and appeared pinched and notched,

and swelling and scar tissue on the inner side of the columella were visible; in the photo at 5 months after removal, the swelling had gone down

and the soft tissue can be seen to have become softer and smoother.

Before the removal surgery the nasal tip was discolored red; after removal the skin color also returned.

Between 1 month and 5 months after removal, there is a difference in the maturation of the skin and soft tissue.

At 1 month after removal, contraction was severe, the nose was more upturned, and the retraction of the columella had also worsened;

at 5 months, after the autologous blood-derived stem cell treatment, the skin and soft tissue had become markedly softer and smoother.

3. February 2023: 3rd surgery at our clinic, 8th overall

CC

The nasal tip had shrunk extremely, and the nose had become shorter.

The bridge was low.

P/E

The septum had collapsed and was deviated, and the nasal cavity was so narrow that even an endoscope could not be inserted.

The nasal tip and alae had shrunk, with severe pinching and notching,

and the columella was also retracted inward.

OP

We built an L-strut septal framework with autologous costal cartilage to lengthen the nose,

and corrected the tip pinching and notching by opening out the alae with alar cartilage grafts (LCSG).

On the dorsum, we performed augmentation with acellular dermal matrix.

As shown, after reconstructive surgery the pinching and notching of the nasal tip improved and the alae opened out,

and as a result the external nasal valve widened and nasal breathing returned to normal.

The nose was not as long as hoped but had lengthened considerably,

and the SSTE (skin and soft tissue) over the dorsum was in better condition than expected, smooth and free of irregularities. 

The pinching and notching of the nasal tip improved markedly after surgery, and the size of the nostrils also returned almost to normal.

After reconstructive surgery, the alae opened out well, and the tip and columella also projected naturally.

After reconstructive surgery, the dorsal line and height, the tip shape, and the columella position came close to those of a normal nose.

The length of the nose left a little to be desired, but because the skin was so stiff and insufficient,

the patient was also satisfied, regarding it as the most that could be achieved.

The columella, which had been bent and retracted, was straightened and projected well after surgery,

and the skin also looks healthy apart from being somewhat thinner. 

Starting 3 months after surgery, to make the SSTE (skin and soft tissue) healthy and soft,

autologous blood-derived stem cell treatment was performed 3 times at intervals of 2-3 months.

2023.5 - 2023.10 (May, August, October): PRP 3 times

As a result, the skin and soft tissue gradually became thicker, more supple, and more elastic. 

By 2 years after reconstructive surgery, the skin and soft tissue had become very soft.

4. July 2025: 4th surgery at our clinic, 9th overall (final surgery)

CC

Upturned nasal tip; tip pinching and notching because the tip had not fully opened out; alar rim retraction; and nostril asymmetry.

(alar rim retraction, notching, asymmetric nostril, nostril show(Lt>Rt)) 

P/E

Removal of the 2-layer autologous costal cartilage spreader grafts and the CS.

Autologous costal cartilage was newly harvested and a new L-strut was made to extend the length.

Because no alar cartilage remained, lateral crural strut grafting was performed with costal perichondrium + autologous costal cartilage.

Augmentation with costal perichondrium, and a cartilage graft (batten graft) of autologous costal cartilage toward the left external nasal valve

A composite graft was performed on the inner side of the right ala.  

Looking back over the history of surgeries at other clinics and at ours,

the patient had 3 surgeries at other clinics in 2005, 2014, and 2015, and after problems arose from the 2015 surgery performed with costal cartilage,

had the first surgery at our clinic in February 2017, using ear cartilage and acellular dermal matrix.

Later, after surgery at another clinic on two occasions, in 2021 and 2022, infection developed again,

and the patient underwent infection removal surgery at our clinic in June 2022 and reconstructive surgery with costal cartilage and acellular dermal matrix in February 2023.

Now, because the patient felt the nose was not long enough and wanted the nostrils covered, we decided, using costal cartilage and perichondrium,

to perform the 4th surgery at our clinic, the 9th overall, in 2025. 

The nasal framework was lengthened with autologous costal cartilage, and the nostril show was covered with alar grafts and a composite graft.

The nostrils, which had been pulled up into a sharp peak, came fully down after surgery and are now naturally covered.

The nose also lengthened markedly, and the skin and soft tissue are smooth and free of irregularities.

By lengthening the framework with costal cartilage, the tip and columella were sufficiently lengthened and brought down after surgery.

After surgery, the tip and columella are much longer, and the nose as a whole looks long and extended.

Before surgery the nose was short and the tip upturned; after surgery the tip came down and the nose became sufficiently long.

The dorsal line is natural as well. 

#ContractedNose #RevisionRhinoplasty #Rhinoplasty #UpturnedNose #WonSukKookPlasticSurgery