L-Shaped Implant Revision Rhinoplasty with Rib Cartilage Reconstruction
- Dr. Chayoung Kang
- 2025년 4월 12일
- 5분 분량
최종 수정일: 5월 19일
This case reviews L-shaped implant revision rhinoplasty in a patient with an upturned nasal tip, deviated nasal bridge, narrow dorsal structure, high radix, reduced nasolabial angle, nostril asymmetry, and columella deviation after previous silicone implant surgeries. Reconstruction focused on L-shaped implant removal, rib cartilage support, septal extension, dorsal reconstruction, radix adjustment, and nasal base alignment.
Author: Dr. Cha-Young Kang
Clinic: NoseLab Clinic
Published: 2024
Last Updated: 2026
Introduction
Hello, this is Dr. Cha-Young Kang of NoseLab Clinic.
This case involves L-shaped implant revision rhinoplasty in a patient who had undergone previous rhinoplasty procedures using both I-shaped and L-shaped silicone implants. After the L-shaped implant revision, the patient developed structural imbalance, an upturned nasal tip, nasal deviation, high radix, and nostril asymmetry.
The surgery was performed using a closed rhinoplasty / endonasal approach. The goal was to remove the L-shaped implant, rebuild nasal support with autologous rib cartilage, adjust the nasal starting point, improve tip position, and correct nasal base imbalance.
Case Background
The patient presented for revision rhinoplasty after previous surgeries involving silicone implants and cartilage support.
The initial surgery used an I-shaped implant with cartilage support. A later revision introduced an L-shaped silicone implant, after which the nasal structure became imbalanced. The nasal tip appeared over-rotated, the bridge deviated, and the nasal base showed asymmetry.
Key Concerns
The key concerns included:
Upturned nasal tip related to implant tension
Deviated nasal bridge
Narrow and unstable dorsal structure
High radix creating an imbalanced profile
Reduced nasolabial angle
Nostril asymmetry
Columella deviation
Weak structural support after previous surgeries
This case required implant removal and structural reconstruction rather than simple contour adjustment.
Preoperative Design and Structural Assessment
Preoperative design consultation photos were reviewed from the frontal, side, oblique, and nostril views.
Frontal View
The frontal view showed nasal deviation, bridge asymmetry, and imbalance of the lower nasal structure.
Side View
The side view showed a high radix, reduced nasolabial angle, and over-rotated nasal tip. The relationship between the nasal bridge and tip appeared imbalanced.
Oblique View
The oblique view showed an uneven dorsal line and structural distortion related to the previous implant position.
Nostril View
The nostril view showed nostril asymmetry and columella deviation. These findings suggested that the nasal base required structural alignment.
The preoperative findings indicated that the problem involved the bridge, tip, septal support, columella, and nostrils together.
Surgical Background – L-Shaped Implant Revision Rhinoplasty
L-shaped silicone implants may place pressure on both the nasal bridge and tip. In some revision cases, this can contribute to tip distortion, skin tension, nasal base imbalance, or long-term structural problems.
A closed rhinoplasty Korea approach was selected to allow internal correction without adding an external columellar incision. The surgical plan focused on removing the L-shaped implant and rebuilding support using a more stable structural framework.
Structural Problems Identified
Preoperative analysis revealed several structural issues related to previous implant surgery and nasal support weakness.
Main Structural Findings
The main findings included:
Structural distortion related to the L-shaped implant
Upturned nasal tip caused by excessive tip support
Nasal deviation and asymmetry
High radix creating profile imbalance
Weak natural structural support
Columella deviation
Nostril asymmetry
These findings indicated the need for implant removal, septal support reconstruction, and nasal base alignment.
Surgical Plan
Removal of the L-Shaped Implant
The L-shaped silicone implant was removed to reduce implant-related structural tension and create a clearer foundation for reconstruction.
Structural Reconstruction with Rib Cartilage
Autologous rib cartilage was used to rebuild structural support. Rib cartilage provided support for the septum, nasal tip, and nasal framework in a revision setting.
Septal Extension and Tip Stabilization
A septal extension graft was used to correct the tip position and improve nasal tip stability. This helped address the upturned appearance caused by previous structural imbalance.
Dorsal Reconstruction with an I-Shaped Implant
An I-shaped implant was used for dorsal reconstruction after removal of the L-shaped implant. The goal was to support the nasal bridge while reducing direct pressure on the nasal tip.
Radix and Profile Adjustment
The radix was lowered and reshaped to create a more balanced relationship between the upper nasal bridge and the rest of the nose.
Nostril and Columella Alignment
Structural correction was performed to improve nostril symmetry and columella alignment. This helped stabilize the nasal base after implant removal and reconstruction.
Surgical Results
Frontal View
From the frontal view, nasal symmetry improved, and the nasal bridge appeared straighter after structural correction. The lower nasal structure also appeared more balanced.
Side View
From the side view, tip over-rotation was reduced, and the dorsal profile appeared more balanced. The nasolabial angle also improved after tip stabilization.
Oblique View
The oblique view showed smoother contour transition and improved structural alignment after implant removal and reconstruction.
Nasal Base View
From the nasal base view, nostril asymmetry and columella deviation improved after structural alignment.
Functional Outcome
The nasal structure became more stable after rib cartilage reconstruction and implant revision. The nasal airway was preserved while the structural imbalance was corrected.
Surgeon’s Commentary
L-shaped silicone implants can create direct pressure on the nasal tip because the implant extends from the bridge toward the tip. In some patients, this may contribute to tip distortion, skin tension, or long-term instability.
In this case, the L-shaped implant was associated with an upturned nasal tip, high radix, nasal deviation, nostril asymmetry, and columella deviation. The correction required more than simply replacing the implant.
Autologous rib cartilage was used to rebuild the structural foundation of the nose. Septal extension was important for stabilizing the tip position, while dorsal reconstruction was planned separately to support the bridge.
Using an I-shaped implant for the dorsum can reduce direct implant pressure on the nasal tip when combined with appropriate cartilage support. However, the surgical plan must be individualized based on tissue condition, previous surgery, and nasal structure.
This case shows that L-shaped implant revision rhinoplasty should be approached as implant removal, structural reconstruction, and nasal base correction rather than simple implant exchange.
FAQ
Why can L-shaped silicone implants cause problems in revision rhinoplasty?
L-shaped implants extend toward the nasal tip and may place pressure on the tip soft tissue. In some cases, this can contribute to tip distortion, skin thinning, upturned tip appearance, or nasal base imbalance.
What is the difference between L-shaped and I-shaped implants?
An L-shaped implant supports both the bridge and tip as one piece, while an I-shaped implant is mainly used for the nasal bridge. In revision cases, the nasal tip often needs separate cartilage support rather than direct implant pressure.
Why is rib cartilage used after L-shaped implant removal?
Rib cartilage may be used when native septal or ear cartilage is insufficient. It can provide support for septal reconstruction, tip stabilization, and nasal framework rebuilding.
Can nasal asymmetry improve after L-shaped implant revision?
Nasal asymmetry can improve when implant-related distortion, septal support weakness, columella deviation, and nostril imbalance are corrected together. The degree of improvement depends on tissue condition and prior surgical history.
International Consultation
For international patients, a photo-based consultation may help clarify whether L-shaped implant revision, silicone implant removal, rib cartilage reconstruction, or nasal base correction may be needed.
WhatsApp: https://wa.me/821057360302
LINE: [LINE Link]
Medical Disclosure
Surgical before-and-after photos show individual patient cases, and results may vary depending on each patient’s anatomy, tissue condition, surgical history, and healing process. Please consult your doctor for an individualized assessment.
After surgery, complications may occur, including infection, bleeding, allergic reaction, asymmetry, limited aesthetic or functional improvement, excessive scarring, skin problems, necrosis, or other complications.
Home page : www.noselab.co.kr
Instagram : noselab_global
Email : noselab@naver.com
댓글