Crooked Tip and Columella Corrected by Removing the Nasal Implant and Septal Extension Graft (SEG): Part 1

Cases in which the tip and columella become crooked and the nose is blocked after nasal surgery 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 become crooked after nasal surgery, identifying the exact cause in this way

and making a surgical plan suited to the individual is most important.

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 left side of the columella protrudes inside the nose. / Frequent blockage of the left side of the nose. / 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- I'd like all of the implant removed and the tip to be soft and movable.

I'd 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 is 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

which is why the patient feels that the skin is stiff and fixed.

A piece of Gore-Tex came out of the mid-dorsum; this was because the middle of the dorsum had sunk in.

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 extension graft cartilage.

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 were well resolved.

After surgery, the tip can be seen to have come down rather than turned up.