Hello, this is Dr. Cha-Young Kang, the director of Nose Lab Clinic.
Today, I’m sharing the case of a patient who experienced complications from multiple previous rhinoplasty surgeries, including inflammation and a contracted nose, due to residual foreign materials. This case highlights the importance of comprehensive corrective surgery and the meticulous removal of problematic materials.
1. Surgical History
2007: L-shaped silicone implant
2021, August: Silicone + ear cartilage (resulted in inflammation)
2023, November: Silicone + mesh + "cat nose" surgery (led to upturned nose)
2023, November: Silicone + autologous rib cartilage + dermis + periosteum (resulted in inflammation treated with PRP 16 sessions)
2. Main Symptoms
Structural Issues: Contracted nose due to chronic inflammation
Inflammation: Persistent swelling likely caused by residual foreign substances
Nasal Tip Collapse: Silicone implant extended to the nasal tip, causing depression
Pain and Tenderness: Particularly in the upper lip and surrounding areas
Left Nasal Obstruction: Caused by residual mesh and deviated nasal septum
Design Consultation: Frontal View, Left Side View, and Oblique Side View Photos
3. Surgical Plan
Structural Reconstruction
Autologous rib cartilage graft for nasal tip and septum reconstruction
Nostril base lowering and nasolabial angle correction
Removal of Foreign Substances
Removal of all residual silicone, mesh, and inflammatory tissue
Functional Improvements
Septoplasty to address septal deviation
Submucosal resection with high-frequency laser for turbinate reduction
Skin Repair and Augmentation
Skin graft using postauricular (behind-ear) tissue to correct contracted areas
Design Consultation: Right Side View, Oblique Side View, and Nostril View Photos
4. Intraoperative Findings
During surgery, the following issues were observed and addressed:
Silicone Implant Malposition: Implant extended to nasal tip, causing tissue thinning and inflammation.
The End of the Silicone Implant Located Just Below the Depressed Skin
Residual Mesh: Mesh remnants were found on the left septal mucosa, causing tension and discomfort.
Mesh Fragments Removed During Surgery
Displaced Cartilage Grafts: Rib cartilage pieces from prior surgery were misaligned, contributing to asymmetry.
The rib cartilage from a previous surgery, shaped for a "cat nose," was inserted tilted toward the right side, causing pain below the right columella. It was determined to be the source of the issue and was removed.
Severe Inflammation: Chronic inflammation and reactive tissue were extensively removed.
Significant Septal Damage: The septum was largely absent and deviated, requiring complete reconstruction with rib cartilage.
5. Pre-Surgical Analysis
Front View
Visible nostril retraction
Pinched alar base
Nasal asymmetry
Crooked nasal bridge
Side View
High starting point of nasal bridge
Short, collapsed nasal tip
Excessive nasolabial angle
Nasal Base
Asymmetrical nostrils
Deviated columella
Pinched and retracted nostrils
6. Postoperative Outcomes
Front View
Before (Left) / Immediately After (Right)
Reduced nostril retraction
Corrected pinched alar base
Improved symmetry and straight nasal bridge
Side View
Before (Left) / Immediately After (Right)
Before (Left) / Immediately After (Right)
Lowered and natural nasal starting point
Stable and properly aligned nasal tip
Balanced nasolabial angle
Nasal Base
Before (Left) / Immediately After (Right)
Enhanced nostril symmetry
Centered columella
Natural and balanced nostril shape
7. Special Considerations
Immediately After Surgery: Frontal, Side, and Oblique Side Views
This case underscores the critical importance of thoroughly removing residual foreign materials during revision rhinoplasty. Chronic inflammation caused by incomplete removal can severely compromise both structural integrity and aesthetic outcomes.
In this instance:
Residual Silicone and Mesh: Fully removed to eliminate inflammatory reactions.
Extensive Reconstruction: Rib cartilage grafts were used to rebuild the nasal septum and tip, ensuring structural stability.
Skin Grafting: Postauricular skin was grafted to restore sufficient nasal coverage and prevent recurrence of contraction.
8. Recovery and Maintenance
Postoperative care included:
Aggressive antibiotic therapy to address residual inflammation.
Stem cell therapy to promote tissue healing and prevent scar contracture.
Ongoing monitoring to ensure functional and aesthetic results remain stable.
Conclusion
This case demonstrates how careful planning, removal of problematic materials, and advanced reconstruction techniques can restore both form and function to even the most challenging cases. At Nose Lab Clinic, we are dedicated to providing personalized solutions tailored to each patient’s unique needs.
If you’re struggling with complications from previous rhinoplasty or similar concerns, we’re here to help you achieve a safe and satisfying outcome.
This is Dr. Cha-Young Kang from Nose Lab Clinic. Thank you for reading.
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