Correction of Pinched Nasal Tip and Retracted Columella – Reconstructive Rhinoplasty After Medpor Removal

By Dr. Cha-Young Kang | Nose Lab Clinic

Hello, this is Dr. Cha-Young Kang, Chief Director of Nose Lab Clinic.

Today, I’m sharing a case of complex revision rhinoplasty involving a pinched nasal tip, shortened columella, and unexpected Medpor discovery—successfully reconstructed using autologous rib cartilage. This patient had undergone multiple surgeries over 15 years, resulting in severe soft tissue and cartilage depletion.

Design Consultation: Frontal View, Left Side View, and Oblique Side View Photos

📍 Surgical History

• 15 years ago: Silicone implant + ear cartilage

• 7 years ago: Silicone + ear cartilage

• 5 years ago: Silicone + ear cartilage (unclear if septal cartilage was used)

🔍 Initial Assessment

Design Consultation: Right Side View, Oblique Side View, and Nostril View Photos

Frontal View

• Noticeable pinching of the alar base

• Retracted and short columella

• Depressed nasal tip, with the alar rims appearing heavy and drooping

• Flat nasal bridge

Side View

• High nasal radix

• Bulbous tip

• Columella barely visible

Functional Symptoms

• Nasal congestion

• Chronic rhinitis

Deviated Nasal Septum and Hypertrophic Rhinitis Observed via Nasal Endoscopy

✨ Patient Goals

• Create a slim, refined nasal line

• Correct pinched alar rims (top priority)

• Lower the columella to achieve visible definition

• Maintain a natural-looking nasal length without elongation

💉 Surgical Approach

1. Intraoperative Discovery

• Medpor implant unexpectedly found in the columella and removed

• Scar tissue and contracted tip excised

• Confirmed severe cartilage deficiency in the alar region

Photos of Removed Silicone Implant, Foreign Materials, and Medpor

2. Structural Reconstruction

• Autologous rib cartilage used to reconstruct alar cartilage

• Rebuilt over-harvested septum using additional rib cartilage

3. Aesthetic Refinement

• Lowered nasal radix for softer facial balance

• Corrected pinched nasal tip

• Elongated the columella naturally to create balance

• Refined alar base and nostril shape

• Adjusted nasolabial angle

✅ Postoperative Results

Before (Left) / Immediately After (Right)

Frontal View

• Significant improvement in pinched alar base

• Columella and tip now gently project downward

• Better definition in nasal bridge width

Before (Left) / Immediately After (Right)

Side View

• Radix lowered for natural start point

• Tip position corrected, eliminating the previous droopy appearance

• Smooth, balanced nasolabial angle achieved

Before (Left) / Immediately After (Right)

Nasal Base View

• Improved nostril symmetry

• More natural alar rim contour

• Pinched areas filled and reshaped

Before (Left) / Immediately After (Right)

Function

• Corrected deviated septum

• Reduced size of inferior turbinates, alleviating nasal obstruction

• Expected relief from rhinitis and nasal congestion

👨‍⚕️ Surgeon’s Perspective

Immediately After Surgery: Frontal, Side, and Oblique Side View Photos

Immediately After Surgery: Nostril View Photos

This case was particularly challenging due to the unanticipated presence of Medpor and significant cartilage loss, especially in the alar and septal regions. The patient had also experienced tip contracture, a shortened columella, and prior graft overuse.

Using autologous rib cartilage, we performed a comprehensive reconstruction, focusing especially on correcting the pinched nasal tip—the patient’s top concern. The columella was carefully lowered for visibility and balance, while ensuring that the nose did not appear excessively long.

We successfully achieved a slimmer, more refined appearance, with structural stability and improved breathing function.

Thank you for reading.

– Dr. Cha-Young Kang, Nose Lab Clinic

https://blog.naver.com/cykang/223827636513