A. To put it simply: yes — capsular contracture reconstruction is entirely feasible through the closed (endonasal) approach, and in many cases it is actually advantageous due to superior tissue preservation and vascular integrity.

​

Here's why.

​

1. Understanding contracture pathophysiology. Capsular contracture occurs when the body forms a fibrous capsule around a silicone implant (a foreign body reaction), and this capsule progressively contracts. The result is a shortened nose with an upturned, retracted tip — sometimes called a “short nose deformity.” Correction requires capsulectomy (capsule removal), implant exchange or explantation, and extension grafting.

​

2. Technical feasibility of closed access. Through the endonasal route, a skilled surgeon can perform complete capsulectomy, harvest and place cartilage grafts (septal, conchal, or costal), and execute septal extension grafts with precision. The NoseLab inner-open technique provides access to even the most complex reconstructive scenarios without an external incision.

​

3. Severe contracture management. In Baker Grade III–IV contracture, structural reconstruction using autologous costal cartilage (rib cartilage) is often necessary. This includes rebuilding the septal framework and re-establishing tip projection and rotation.

​

---

​

Why the Closed Approach Makes a Difference

​

The most significant advantage in contracture cases is preservation of the columellar blood supply. Patients with capsular contracture have often undergone multiple prior surgeries or experienced inflammation, leaving the nasal skin compromised. An open approach requires a transcolumellar incision that further jeopardizes the already-tenuous skin vascularity. The closed technique eliminates this risk entirely. Furthermore, minimal soft tissue elevation means less additional fibrosis — directly reducing the risk of re-contracture.

​

---

​

When to Be Cautious

​

- Patients with extreme skin thinning combined with severe contracture require especially careful surgical planning.

- A history of 3 or more prior surgeries or documented infection necessitates thorough tissue assessment before committing to reconstruction.

- Patients with prior contracture carry a statistically higher risk of re-contracture.

- In select cases, staged reconstruction — addressing the capsule and inflammation first, then performing definitive reconstruction later — may be the safer approach.

​

---

​

What I've Observed in Clinical Practice

​

In my clinical experience, the majority of capsular contracture patients achieve successful outcomes through the closed approach. For Grade II–III contracture, a combination of septal cartilage and conchal (ear) cartilage grafts provides stable restoration of nasal length and tip deprojection. For severe Grade III–IV cases, I utilize autologous costal cartilage to reconstruct the septum and redesign the tip framework via septal extension grafting. Rib cartilage remains the most dimensionally stable graft material for tip work.

​

---

​

Surgeon's Note

​

Capsular contracture is not a cosmetic problem — it is a structural reconstruction. Simply removing the implant does not solve the underlying issue; the nasal support framework must be redesigned. As a surgeon who has performed all revision and reconstructive rhinoplasty exclusively through the closed technique, I place great importance on addressing both function and structural integrity in every procedure.

​

---

​

Summary

- Capsular contracture reconstruction is fully achievable via the closed endonasal approach, with superior vascular preservation

- Graft options include septal, conchal, and costal cartilage depending on contracture severity (Grade II–IV)

- Prior contracture history increases re-contracture risk; meticulous assessment and possible staged surgery are essential