Tip Cartilage Repositioning and Nasal Implant Removal (Definition, Necessity, Methods)

The term “tip cartilage repositioning” is used in two different situations.

1) Rhinoplasty and “Tip Cartilage Repositioning”

In rhinoplasty, to give the nasal tip a more attractive shape,
the tip cartilage may be brought together, moved, reduced, or propped up, among other techniques;

surgical techniques that manipulate the tip cartilage in these various ways are called “tip cartilage repositioning”.

2) “Tip Cartilage Repositioning” and Implant Removal

When side effects from an implant after rhinoplasty
cause the nasal tip to turn upward or become deformed, the tip cartilage needs to be restored while the implant is removed .

The restorative procedure that returns such deformed tip cartilage to its original position and shape is also often called “tip cartilage repositioning”.

Because the term “tip cartilage repositioning” is applied to these two situations,

it often causes misunderstanding and confusion among the general public.

The “tip cartilage repositioning” covered in this case study

is the procedure performed on a nose that developed problems after previous rhinoplasty: together with implant removal, the deformed nasal tip

is returned to its original state.

  

In Asian patients, rhinoplasty typically combines augmentation rhinoplasty, which raises the dorsum using an implant or human donor tissue, with tip plasty using autologous cartilage.

 

-Tip Plasty Techniques

1) Tip cartilage reduction

2) Bringing the tip cartilages together

3) Propping up the tip cartilage (columellar strut)

4) Tip lengthening (septal extension graft)

5) Tip shortening6) Tip cartilage onlay graft

 

When performing “implant removal” and “tip cartilage repositioning” to restore the tip cartilage,

the surgeon needs to know which tip plasty technique was used previously

in order to operate accurately and safely.

  

<Various Cartilage Grafting Techniques for the Nasal Tip(Various cartilage graft on nasal tip)>

 

03. Tip Cartilage Repositioning and Nasal Implant Removal

(Removal of nasal implant and tip cartilage reposition)

1) What Are “Tip Cartilage Repositioning” and Implant Removal?
A typical rhinoplasty uses an implant and autologous cartilage to raise the nasal bridge and refine the nasal tip.

However, problems can arise from the implant or from an unsatisfactory result.

-Contracture caused by a silicone implant on the dorsum

-The nasal tip is compressed or displaced by the implant

-An aesthetic deformity appears after various tip plasty procedures

In such cases, restoring the tip cartilage to its original shape and position

(restore the shape and position of tip cartilage) is called “tip cartilage repositioning”.

 

2) Why “Tip Cartilage Repositioning” Is Necessary

Among the tip cartilage deformities that appear after rhinoplasty with a silicone implant,

the most common problems are as follows.

 

Commonly Seen Tip Cartilage Deformities

  i) Upturned nasal tip (Upturned nose)

  ii) Deviated or tilted columella (Shifted columella)

  iii) Nostril asymmetry (Asymmetric nostril)

  iv) Tilted and distorted tip cartilage (Deformed tip cartilage)

  v) Excessive nostril show with alar retraction (Nostril notching)

  vi) Nasal tip deviated by skin tension after a septal extension graft (Twisted, shifted nasal tip)

 vii) Nasal tip deviated by asymmetric fixation during tip surgery

 viii) Pinched nasal tip (Pinched tip)

 

If only the implant is removed without tip cartilage repositioning,

deformity of the nasal tip (tip deformity) becomes severe,

so tip cartilage repositioning must be performed together with it.

“Tip cartilage repositioning” is the most important surgical step in determining the shape of the nasal tip after implant removal.

  

3) Methods of “Tip Cartilage Repositioning”

At most clinics, implant removal and tip cartilage repositioning are generally performed through an open approach.

At Won-Suk Kook Plastic Surgery, except in special cases, more than 90% of cases use a closed approach (intranasal incision) for both implant removal and tip cartilage repositioning, aiming for a quick recovery,
with minimal scarring.

The technique resolves contracture by releasing all the forces that are holding the tip cartilage in place.

The cartilages are then secured to each other at the columella with supporting sutures,
or sutured after a strut is placed, neatly correcting a deviated columella, nostrils, asymmetry,
a contracted nose, and similar problems.

  

04. Features of Tip Cartilage Repositioning at Won-Suk Kook Plastic Surgery (Special things of Dr. Kook’s tip cartilage reposition)

1. Implant removal, and tip cartilage repositioning are both performed through a closed approach (large Medpor implants, mesh plates, severe inflammation, adhesions, and similar cases may require an open approach)

  2. Cartilage previously grafted to the nasal tip is removed and reused > no additional cartilage grafting

  3. No new alteration is made to the tip cartilage

  4. Tip cartilage deformed by previous surgery is restored to its original position

 

  1) Releasing cartilage fixed to a strut or extension graft

  2) Separating tip cartilage pulled upward by contracture from the surrounding tissue and releasing it

  3) Correcting nostril asymmetry, columellar deformity

  4) Restoring tip cartilage compressed or displaced by silicone to its original shape, position 5) Releasing the cartilage of a pinched tip to restore a natural appearance

  5. A quick recovery period of about 1 week

 

  

The key is to carry out the steps in the order A,B,C,D, gently releasing the tip cartilage (shown in blue) from the surrounding cartilage and tissue.

Through this process, the original tip cartilage that had been pulled upward can return to its proper position.