Contracture After Rhinoplasty with Silicone and Gore-Tex (Nasal Contracture, Contracted Nose Surgery, Contracted Nose Correction)
Because contracted nose correction must resolve several problems at once, it is, among nasal surgeries,
a demanding and complex operation.
That is, the skin and framework shrunken by contracture must be lengthened, and the tip cartilage, deformed in three dimensions,
must be restored symmetrically.
PH
1st surgery (9/2009): augmentation rhinoplasty with silicone and tip plasty with septal cartilage (open approach)
2nd surgery, 6 months later: silicone removed and replaced with Gore-Tex.
CC
Throbbing and stiffness on the right side of the bridge only; contracture; nostril show.
P/E
The right ala was depressed, and the tip tilted to the right.
The columella was also tilted, and the dorsal skin had thinned so that the implant showed through.
The tip was markedly upturned;
the implant had migrated upward and the tip was upturned, which confirms that contracture had developed.
OP
Gore-Tex had been placed in 1 layer on the dorsum and in 2 layers above the tip => removed.
The tip had an extension graft made of septal cartilage => septal extension graft removed.
The remaining septum was very weak, giving a saddle nose shape with the lower dorsum collapsed.
(The Gore-Tex was presumably placed in two layers during the previous surgery to compensate for this.)
To reinforce the weakened septum, a septal extension graft and
a PDS plate applied to the septum in an L-strut shape were used for reinforcement.
A columellar strut (C.S) + derotation graft were placed using ear cartilage.
Left Photo
After removal of the Gore-Tex, inflamed tissue, and scar tissue.
Right Photo
Removing the septal extension graft.
Left Photo
The septal cartilage, weak and bent.
Right Photo
The septum reinforced with septal cartilage and a PDS plate. The septum has been straightened.
Final appearance after the columellar strut and derotation graft.
The tip, which was upturned and crooked before surgery, has come down and straightened.
The pinched tip can also be seen to have opened into a natural, rounded shape.
The tilted columella and nostrils became straight, and the nostril asymmetry was completely corrected;
the surgical scar is also barely visible at 4 months.
The upturned tip has come down, and the dorsal line also looks natural after removal of the Gore-Tex.
The length has increased sufficiently, and the dorsal line looks natural.