Pinched Nasal Tip and Nostril Retraction (Pinching & Notching) 04

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.

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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.

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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).

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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.

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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.

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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 - 20 years ago, simple augmentation rhinoplasty with silicone through a closed approach at another clinic

-> Afterward, the glabella area became uncomfortable, the nostrils became visible, and the patient was dissatisfied with the shape.

4 years ago, the patient had surgery with silicone + septal cartilage (strut, onlay) through an open approach at another clinic.

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C.C - The nose looked attractive after surgery but gradually became shorter. Starting 1 year after surgery, the glabella swelled

and was painful (6-7 episodes); the last inflammatory response occurred 15 days ago.

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Physical Examination - There was slight pinching, and the notching was relatively severe.

Contracture has retracted the nostrils, which are asymmetric. The silicone implant

has ridden too high and looks unnatural, and the nasal bridge is thick because of scar tissue and the capsule.

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Surgical plan - Release the tip cartilages that have been pulled upward and shrunken by contracture,

and perform a lateral crural strut graft (LCSG) using ear cartilage.

For the dorsum, the plan was to remove the silicone and capsule and supplement with acellular dermal matrix.

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*Point: Because contracture has made the pinching and notching, the tip cartilage deformity, and the upturned nose quite severe, a closed approach

with removal of the implant, capsule, and grafted tip cartilage and simple tip cartilage repositioning alone would be unlikely to correct them. Therefore, to correct them,

an open approach is needed, along with a combined repositioning of the tip using a lateral crural strut graft and a derotation graft.

The photo on the left shows the lateral crural strut graft made with septal cartilage that remained inside the nose,

and the photo on the right shows the removed silicone and capsule. Because the contracture was severe, the capsule was also very thick and tough.

The notching and pinching that were severe on the patient's left (the right in the photo) are gone,

and the retracted nostrils have come down naturally on both sides. The dorsum, which had been thickened by a mass of

scar tissue and capsule, can be seen corrected to a slim, straight shape after surgery.

The nostril asymmetry and nostril pulling have been completely corrected.

In addition, the nose can be seen to have regained a natural curve.

The nose is longer, which has improved the nasolabial angle,

and a natural nasal line can be seen in the side view as well.