Crooked Tip and Columella Corrected by Removing the Nasal Implant and Septal Extension Graft (SEG): Part 2

The commonly cited causes fall into 4 cases.

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

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 dorsal skin 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.

The patient would also like the columella and nostrils to be straight and symmetric.

As a result, the nasal passage was narrowed and the columella was tilted.

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.

the weakened septum could be seen to have tilted diagonally.