What Is Protruding Inside the Nose, Next to the Columella? (Nasal Implant Extrusion / Nasal Implant Removal / Nasal Silicone Removal)
What Is Protruding Inside the Nose, Next to the Columella?
Quite a few people find that, some months after rhinoplasty, they can feel
something protruding inside the nose next to the columella.
They come for a consultation worried that silicone might be coming out; as they fear,
it must be carefully distinguished whether this is silicone, grafted cartilage, or buckled tip cartilage.
Today's case shows buckled columellar cartilage of the nasal tip corrected through a closed approach.
PH
6 years ago: dorsal silicone + ear cartilage and AlloDerm grafted on top of the nasal tip. (Open approach)
CC
The outline of the dorsal implant shows through, and the tip cartilage shows through;
recently the nasal tip has turned red, causing anxiety.
Want
Wants all implants and grafts removed to return to the original appearance.
P/E
Silicone 4-5 mm thick can be felt in the dorsum,
the glabella is high and the nose looks long because of the silicone, and the outline of the silicone is visible.
The columella is tilted. Inside the nose, a protrusion is visible on the right side of the columella.
P/E
On the right side of the columella, something pea-sized with a well-defined border protrudes.
Diagnosis: on palpation, it is not connected to the dorsal silicone and is thought to be buckled columellar cartilage.
The reason is that ear cartilage is grafted by placing it like a cap over the tip cartilages,
so it is not a piece of ear cartilage, and no columellar strut could be felt.
The right photo shows the silicone, capsule, and piece of ear cartilage that had been on the nasal tip, removed from inside the nose.
The left illustration shows the patient's internal structure before surgery.
No strut could be felt within the columella, and as the silicone implant pressed on the tip cartilages,
the columellar cartilage (middle crus) buckled and bulged out.
After the silicone, capsule, and tip ear cartilage were all removed, the buckled columellar cartilages were sutured together and straightened.
When something bulges on the inner side of the columella like this, three possibilities should be considered.
1. A columellar strut or cartilage graft protruding - the strut or a cartilage fragment can be felt.
2. Silicone pushing down - usually protrudes from above rather than from the side
3. Buckled columellar cartilage
This photo was taken immediately after surgery. After all implants and grafts inside the nose were removed through a closed approach,
the buckled right columellar cartilage was sutured to the left one so that it would straighten.
The protruding fragment can no longer be seen or felt, and the columella is straight.
Once the dorsal silicone implant and the ear cartilage on the nasal tip were all removed,
the crooked bridge became straight, and with the implant outline gone, the nose looks natural.
The columella is straighter, and nostril symmetry has improved.
The cartilage that had buckled and protruded at the upper inner part of the right columella
can be seen to have flattened and receded.
The dorsal height is somewhat lower, but not strikingly so,
and the nose can be seen to have a natural line.