Correction of Pinching and Notching Caused by a Contracted Nose (Contracted Nose Correction, Revision Rhinoplasty)

Correction of Pinching and Notching Caused by a Contracted Nose

PH

20 years ago: silicone implant for the bridge (closed approach).

15 years ago: silicone implant for the bridge + tip plasty (open approach) + alar reduction (lateral).

10 years ago: replacement of the bridge silicone (open approach).

CC

The nose had shortened and the tip had shriveled. Breathing felt obstructed.

P/E

Tip deformity due to contracture (shortened length, folded tip) 

Webbing of the incision scar inside the nostril. Pinched tip; retracted columella.

The columella is retracted,

and the lateral photo shows that the tip is markedly upturned.

Because of contracture, the alae at the tip are severely pinched,

the tip is upturned, and the silicone has migrated upward.

(Surgical Plan)

After removing all of the silicone, capsule, inflamed tissue, and scar tissue,

the plan was to lengthen the nose with autologous costal cartilage and to open out the folded tip with a lateral crural strut graft of the tip.

After the dorsal implant and scar tissue were removed,

dissection of the septum reveals a bent septal extension graft (batten type).

This is the original septal cartilage revealed after the crooked septal extension graft was completely removed.

(Left Photo)

An “L” strut (L-shaped strut) was built on the septum with autologous costal cartilage, together with a lateral crural strut graft.

(Right Photo)

Appearance after suturing was completed.

Appearance at 3 weeks after surgery.

​

The nose has lengthened sufficiently, and the folded tip has opened out completely.

The retracted columella has also come forward markedly.

The pinched tip has opened out, and the web-like scar tissue can also be seen to have improved.

The tip has gained projection after surgery.

The pinched, shriveled tip has opened out naturally.

The nose had shortened because of contracture,

leaving the tip markedly upturned and the columella retracted; the tip has now lengthened sufficiently,

and the columella has clearly come forward.