Nasal Tip Diced Rib Cartilage Removal Case

As the view that autologous tissue rhinoplasty is safer and more natural has spread,

the number of rhinoplasty cases using autologous cartilage is increasing.

Autologous tissue is certainly a good material for plastic surgery,

but good results depend on choosing the right type and site of autologous tissue.

For example, the material used to raise or lengthen the nasal tip should preferably be soft

and elastic cartilage, so ear cartilage or septal cartilage is commonly used.

The dorsum requires a large volume of tissue, so among autologous tissues, dermis or diced cartilage is used.

When ear cartilage, septal cartilage, dermis, and the like have all been used and none remains, costal cartilage is generally the option to consider.

Recently, however, we have been seeing nasal surgery performed with diced costal cartilage, in which rib cartilage is finely crushed into tiny fragments.

Diced costal cartilage is soft at first, but over time it gradually hardens into a solid mass.

The nose becomes hard and, in some cases, a severe foreign body sensation develops, causing great discomfort.

When a large amount of diced costal cartilage is placed in the columella or nasal tip to raise the tip,

the tip becomes hard, leading to a severe sense of pressure and foreign body sensation, which causes discomfort and strains the skin.

Diced costal cartilage should therefore not be used indiscriminately,

and in our view it is advisable to use a moderate amount only for raising the dorsum.

This patient had diced costal cartilage placed in the columella and nasal tip at another clinic 3 years ago to raise the tip.

Since then, as the diced cartilage hardened, the nasal tip became firm with a strong sense of pressure, and the tip drooped downward.

The feel of the nasal tip was hard, and a mass of cartilage could be felt.

The skin of the nasal tip had thinned, and the mass of hardened diced cartilage was showing through.

The nasal tip could not bear the weight of the cartilage and drooped downward like an arrow-shaped nose.

We marked the extent of the cartilage palpable in the nasal tip and planned the dissection.



Surgery was performed through a closed approach for faster recovery and a smaller area of scarring.
Because the diced cartilage had hardened into a mass, we dissected all around the mass, separated it cleanly, and removed it.

The diced cartilage that had been injected into the nasal tip with a syringe had been pushed upward by the injection pressure

and had reached the area above the tip,

and the diced cartilage that was removed had hardened into a mass.

The mass of diced cartilage was removed through incisions inside both nostrils.

This is the appearance 2 months after surgery.

With the mass of diced cartilage that had been protruding and showing through at the tip removed, the tip has become round and soft.

The nose, which had been hard because of the hardened diced cartilage, became soft,

and the patient said the discomfort from the pressure was gone and the nose felt comfortable.

The nasal tip also moves freely again, and the nose is soft and supple once more, so the patient can make the so-called "pig nose" without difficulty.

The fragments of diced cartilage that had shown through at the tip are gone, and the tip, which had looked pointed and sharp because the diced cartilage had sagged, has returned to a round, natural shape.

The tip, which had pointed sharply downward, now looks soft, and the arrow-shaped drooping has also improved naturally.

Above all, the patient shared that the pressure and severe foreign body sensation in the nasal tip were completely gone and that it felt liberating.