Pinched Nasal Tip and Nostril Retraction (Pinching & Notching) 02
Quite a few people want to have a silicone nasal implant removed but hesitate after hearing that, once it is removed, the tip may look pinched
or the nostrils may become retracted.
If this kind of pinched-tip deformity (Pinching, Notching) actually appears after surgery,
what are the causes and solutions? Let us look at them closely through cases.
1. To prevent the capsule remaining inside the nose (silicone capsule) from causing contracture
and lifting the tip, and to release, even slightly, any contracture that has already occurred.
2. Through tip cartilage repositioning, to release tip cartilages that were pinched when they were sutured together or
fixed to a strut during the previous surgery, so that the tip becomes natural.
Compared with method B, method A is naturally less effective at correcting pinching and retraction.
In other words, A can be expected to keep the condition from worsening and bring slight improvement,
while method B can clearly release the pinched tip (Pinched tip, Nostril notching).
However, with closed-approach simple repositioning, because the tip cartilages were damaged and
deformed by the earlier surgery and are therefore weak, during the 3-6 month contraction period after removal and repositioning,
the tip may become more pinched or turn up slightly.
In such cases, when nasal tip rehabilitation (massage, stretching, and tip mobility exercises) is combined with a nostril support device (nasal retainer),
the pinched and retracted shape mostly recovers once the contraction period has passed.
To help explain this, case photos are used as examples below.
7-8 years ago at another clinic, through an open approach, this patient
had tip plasty with ear cartilage and silicone placed in the dorsum; contracture has now led to
a pinched tip, nostril notching, and an upturned nose, among other changes.
This patient had tip plasty with ear cartilage and augmentation of the nasal bridge with silicone at another clinic 5 years ago,
and developed a tilted columella (Shifted Columella), nostril notching, and, due to contracture,
an upturned tip. The pinching is relatively mild.
We have now seen what tip pinching, alar rim retraction (Nostril Notching),
and an upturned nose are.
Now let us look at Won-Suk Kook Plastic Surgery's
cases of resolving the pinched tip and nostril retraction that occur after implant removal.
P/H - 5 years ago at another clinic, through an open approach, this patient
had rhinoplasty with silicone, septal cartilage, and ear cartilage.
C.C - There were no particular symptoms, but the tip was fixed in place,
and the patient wanted removal surgery out of anxiety about silicone side effects.
Physical Examination - The tip was firm and fixed, with slight notching
at the tip; the silicone implant was in a normal position, but its outline was visible.
As shown, during the contraction period after surgery, soft tissue contraction caused the weakened
tip cartilages to curl inward, producing pinching and notching;
in the photo at 4 months, however, the contraction has almost fully released and the nose has returned to normal.
*Summary: This patient had slight pinching and notching before removal,
but because they were not severe, only removal and simple cartilage repositioning were performed. Right after removal, pinching and notching
appeared on one side, but here too, after rehabilitation and wearing the support device for 4 months, the nose returned to its original state.