Contraction and Relaxation Periods After Removal of Nasal Silicone and Ear Cartilage

After surgery to remove the nasal implant, capsule, and tip ear cartilage and reposition the tip,

the shape of the nose can be seen to change little by little during recovery.

Right after surgery, the hard, stiff bridge and tip feel softer,

but after 3-4 weeks the tip stiffens again, and pinching, notching,

and an upturned tip may appear.

With massage and rehabilitation at this stage, after 3-6 months a natural appearance and

a soft feel can be seen to return.

Past History- Filler injections 3-4 times.

2 years ago, silicone + donor costal cartilage (septal extension graft) + tip ear cartilage + open approach at another clinic

Chief Complaint- The tip is short and upturned

The outline of the silicone shows

The glabella is high and the silicone seems to float

Wants everything removed but worries that the nose may look odd afterward

Physical Examination- The tip is rounded and bulbous / The silicone on the dorsum is wide and thick

PLAN- Removal and repositioning

The septal extension graft attached to the left side of the septum (caudal septum) was visible to the naked eye.

The patient said that donor costal cartilage had been used for it.

Before removal, the columella hangs well down, yet the height and definition of the tip are insufficient.

This is because the septal extension graft made with donor costal cartilage did lengthen the nose,

but was not effective in raising the height of the tip.

Surgery- Through a closed approach, the silicone, donor costal cartilage (septal extension graft), septal cartilage placed on the tip,

and capsule were all removed, followed by tip cartilage repositioning

As the photo taken on day 18 after surgery shows, soon after surgery the tip looks pinched and the nostrils are drawn upward,

showing the pinching & notching phenomenon.

If massage, tip rehabilitation exercises, and a support device are used from this point, the tip gradually relaxes into a natural shape.

At 2 and 4 months after surgery, the nose has also lengthened and the nostrils are less visible.

 In the photo at 4 months after surgery, the pinching of the tip is entirely gone, and the scar and hardened scar tissue have all resolved.

In the photos before and right after surgery, the nostrils were pointed and elongated upward, but in the photo at 4 months after surgery

the nostrils are a natural oval, and the tip has also taken on a rounded, soft curve.

Right after surgery the nose was markedly upturned and looked pinched,

but over time the nose has gradually lengthened and the tip definition has become clearer, giving a natural look.

Right after removal the tip was upturned, but over time

it gradually came down and became soft and natural.

This shows that care and rehabilitation remain important even after nasal implant removal.