Contracted Nose Surgery Cases

1-1 Thick scar tissue bunched in the dorsum and tip

1-2 The nose turned up and shortened into an upturned (short) nose

1-3 Various tip deformities, including pinching, twisting, nostril asymmetry, and notching

1-4 The outline of the dorsal silicone implant clearly visible

Upturned tip, pinching, alar rim retraction (notching), nostril asymmetry, tilted columella

Twisted and upturned tip, notching, nostril asymmetry, tilted columella

Notching, pinching, tilted columella, nostril asymmetry

Notching, tilted columella, nostril asymmetry

1) To eliminate the cause of the contracture, the silicone, capsule, and scar tissue are removed.

2) Using autologous cartilage, the gap between the middle cartilages and the tip cartilages is widened, lengthening the nose.

  The most commonly used lengthening methods are:  

  - Septal extension graft or extension wedge graft using costal cartilage.

  - Downward rotation graft using ear cartilage (Derotation  graft)

3) When greater dorsal height is desired, it is raised using acellular dermal matrix, a human donor tissue.

Case 1.

Correction Point: The nose had been shortened by contracture, so it was lengthened; bridge height kept about as it is. 

History: Augmentation rhinoplasty and tip plasty with silicone on 3 occasions, beginning 20 years ago. 

Surgical Method: After removal of the silicone, capsule, and scar tissue, derotation graft with ear cartilage and augmentation rhinoplasty with acellular dermal matrix.

Case 2.

History: 4 surgeries with silicone, beginning 8 years ago.

Correction Point: Correct the upturned nose caused by contracture and the various tip deformities. Raise the bridge in balance.

Surgical Method: Derotation graft and alar cartilage graft with ear cartilage; augmentation rhinoplasty with acellular dermal matrix.

Case 3.

History: 4 surgeries with silicone, beginning 8 years ago. Afterward, discharge from the nose and persistent infection, with contracture gradually developing.

Surgical Point: Upturned nose and severe, varied tip deformities.

Surgical Method: After complete removal of the silicone, capsule, and scar tissue, lengthening, lateral crural strut graft, and augmentation rhinoplasty were performed with autologous costal cartilage.