Crooked Tip and Columella Corrected by Removing the Nasal Implant and Septal Extension Graft (SEG): Cases
Crooked Tip and Columella After Rhinoplasty
Cases in which the nasal tip and columella become crooked and nasal obstruction develops after rhinoplasty are surprisingly common.
There are 4 commonly cited causes.
01. The nasal implant was placed crooked
02. The columella became crooked because the columellar strut was sutured incorrectly when it was fixed
03. The septal extension graft was placed on one side only
04. The cartilage graft placed on the tip sits off to one side
When the tip and columella are crooked after rhinoplasty, identifying the exact cause in this way
and making a surgical plan suited to the individual is the most important thing.
Case 1: Crooked Tip and Columella After Rhinoplasty
Past History- 10 years ago, augmentation rhinoplasty with silicone was performed at another clinic through an open approach,
and tip plasty was performed with septal cartilage.
Chief Complaint- The column on the left inside the nose protruded. / The left side of the nose was often blocked. / There was no pain, pressure, or swelling.
Physical Examination- The skin of the dorsum was stiff and thin. The silicone implant was tilted diagonally. The columella was tilted, and the nostrils were asymmetric. The tip was fixed, immobile, and firm.
WANT- The patient would like all of the implants removed and the tip to be soft and mobile.
The patient would also like the columella and nostrils to be straight and symmetric.
In this patient, protruding cartilage on the septal side inside the left nasal cavity could be seen and felt.
As a result, the nasal passage was narrowed and the columella was tilted.
As the photo on the left shows, the silicone was shifted to the (patient's) left
and was pressing on the left tip cartilage, which can be seen to be buckled.
Once the silicone was removed, the thick capsule appeared white; it is this capsule
that gives the patient the stiff, fixed feeling.
A piece of Gore-Tex was found in the middle of the dorsum; the middle of the dorsum had been depressed,
and it was found to have been layered with the silicone to reinforce that area.
After the silicone and capsule were removed and the septal extension graft was removed as well,
the weakened septum could be seen to have tilted diagonally.
The silicone, capsule, and Gore-Tex were removed, and the bent septum was straightened using the cartilage from the extension graft.
After surgery, nasal breathing improved and the deviated tip returned to the midline.
At day 10 after surgery the patient is still recovering and some swelling remains, but the tip has become soft and supple.
The patient also reported that breathing is comfortable.
Both the nostril asymmetry and the columellar deviation can be seen to have been well resolved.
After surgery, the tip can be seen to have come down rather than turned up.
Case 2: Crooked Tip and Columella After Rhinoplasty
Past History- 7 years ago, silicone + septal strut + ear cartilage at another clinic (open approach)
2 years ago, the tip cartilage became prominent and was trimmed.
Chief Complaint- Foreign body sensation in the right side of the tip. / Slightly upturned nose. / Nostril asymmetry
Physical Examination- The silicone was shifted to the left; nostril asymmetry.
A piece of grafted cartilage protruded inside the right side of the nose. The tip was firm, fixed, and immobile.
WANT- "I don't want anything else put back in. As long as it doesn't turn up any more than it is now, that's fine."
PLAN- Removal of (silicone + septal strut + derotation + ear cartilage onlay) + tip cartilage repositioning
The cartilage protruding inside the right side of the nose was judged to be a protruding piece of
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