Hello, I am Dr. Chayoung Kang, Director of Noselab Rhinoplasty Clinic.
Today I will introduce the case of a 31 year-old male patient. This case is an important example of the importance of using an appropiate prosthesis and undergoing a safe rhinoplasty. Rhinoplasty does not only have cosmetic effects, but it also has a functional side too, so it requires an expert approach.
Preoperative Design Consultation
This patient had previoulsy received a semi-curved nose shape rhinoplasty, and now wanted a manly straight nose. This is a case in which the patient’s requirements regarding rhinoplasty change over time. The main issues detected during design consultation were the following:
The silicone implant had been inserted from the bridge to the nasal tip.
Skin at the nose tip was becoming increasingly thin (tilting, and risk of protrusion)
Blunt nose tip
It appeared to be a generally feminine nose.
Wide nose bridge.
Asymmetric nostrils.
These issues are result of the previous surgery, especially the insertion of the silicone implant up until the nose tip is the biggest issue. This is a procedure that can lead to great complications.
The patient’s requirements:
Change into a manly straight nose.
Increase the height of the nose tip and bridge.
Improve the wide nose bridge.
Improve the nostril shape.
Maintain a natural-looking nose shape in general.
Surgical Plan
The CT scan image confirmed that the silicone implant was inserted until the nose tip. The area highlighted in yellow is the silicone implant.
Based on the CT scan results, a detailed surgical plan was developed as follows:
a) Removal of existing silicone implant: Safely removing the silicone implant inserted all the way to the tip of the nose that presented a risk.
b) Reconstruction of the nose tip using autologous costal cartilage: Strengthening structural support of the tip of the nose, and creating a natural nose tip shape.
c) Reinforcement of the skin at the nose tip: Reinforcing the thin skin by using artificial dermis. Additional skin strengthening using scar tissue.
d) Insertion of a new silicone implant into the bridge of the nose: Using a 7mm prosthesis (2mm higher than the current one). Partial insertion into the bridge of the nose to ensure safety.
e) Removing the curve at the nose bridge: Creating a masculine image by turning it into a straight nose. f) Nostril correction: Improving the asymmetry and the shape. g) Adjusting the nasolabial angle: Turning into a more natural-looking nasolabial angle.
Surgical content
a) Removal of the silicone implant: First, the current silicone implant that had been inserted all the way to the tip of the nose was carefully removed. During thisprocess, we took great care to minimize the damage to the surrounding tissue.b) Reconstruction of the tip of the nose: Hervesting the autologous costal cartilage and using it to reconstruct the tip of the nose. Costal cartilage has sufficient strength and flexibility to stably support the structure of the tip of the nose. The shape of the tip of the nose was carefully sculpted to create a natural look.The thin skin of the tip of the nose was reinforced using artificial dermis. This significantly reduces the risk of future prosthesis protrusion, etc. Additionally, the skin thickness was further strengthened by using scar tissue. c) Increasing the height of the nose bridge: A new 7mm high silicone implant was partially inserted only into the bridge. This is about 2mm higher than the previous one. The position and size of the prosthesis were carefully determined to ensure a natural-looking height. d) Adjusting the curve of the bridge: The nose bridge curvature was eliminated and the bridge was shaped into a straight line. This helps to emphasize the masculine image that the patient requested. e) Improving the nostril shape: The asymmetrical shape of the nostrils was corrected to create a balanced shape. The overall nostril contour has been refined to create a more refined look. f) Adjusting the nasolabial angle: Improved the overall facial balance by adjusting the angle between the tip of the nose and the philtrum in a natural-looking manner.
During the surgery we paid special attention to the blood circulation to the tip of the nose. Since the skin was already excessively thin from the previous surgery, it was imperative not to inflict additional damage to the tissue.
Before and After Surgery Photos
The blunt nose tip was improved. The nose tip, which previously looked flat and wide, now has an appropriate amount of projection and three-dimensionality.
The appearance of the wide nose was improved. The bridge of the nose looks slimmer, and the overall nose contour has become more clear.
The bridge of the nose, which was previously flat and crooked, became straight. This is plays a great role in emphasizing a masculine image.
Improved nostril asymmetry for a more balanced look.
The height of the bridge of the nose was generally increased, giving a more three-dimensional appearance.
The curve of the nose bridge has disappeared and changed into a masculine straight nose. This is a result that accurately reflects the patient’s needs.
The tip of the nose was raised and the columella was slightly lowered, naturally correcting the nasolabial angle. This resulted in better harmony between the nose and lips.
The nose has become more masculine and three-dimensional. It now has a much clearer outline than before
The projection of the tip of the nose was appropriately adjusted to create a natural look.
The line from the bridge to the tip of the nose has become smoother and softer.
The round and asymmetrical nostrils have been adjusted. The shape of the nostrils when viewed from below has changed to a more natural and balanced shape.
The size of the nostrils is appropriately adjusted to create harmony with the overall balance of the face.
The nose was raised as much as possible as the patient requested and within the safety limits. When we compare the side profile view, it is possible to observe the height of the nose has clearly increased. But, it is not only the nose bridge height that has increased, but also the nose tip was raised and the overall appearance now looks more balanced.
After Surgery Table Photos
Overview
In this case, it is possible to observe the cosmetic and safety effects at the same time during rhinoplasty surgery. In rhinoplasty, the material that has the most effect in the nose bridge height increase are silicone implants. Moreover, depending on the location where it is inserted, it may also present a risk. Especially when a silicone implant is inserted in the nose tip, it can present the risk of complications, such as inflammation, protrusion and/or others, and, therefore, it must be avoided.
One of the core principles to ensure a safe rhinoplasty surgery is to use autologous materials, such as autologous cartilage and dermis, for the nose tip. In this case, to follow the core principle, we removed the dangerous implant and used the self-rib cartilage to reconstruct the nose tip, and used a new silicone implant only on the nose bridge.
Moreover, in this case we can also see the importance and complexity of revision rhinoplasty. We corrected the deformation caused by the previous surgery and, at the same time, we tried to comply to the patient’s needs, making it a delicate and complex process. Especially, great care was required since the skin had become thin.
Through this surgery, we were able to achieve the following improved effects:
Securing a safe structure: Removing the damaging silicone implant and replacing it with autologous tissue.
Building a masculine straight nose: Transforming the nose into a natural-looking straight nose according to the patient’s needs.
Improving the overall height of the nose: Adjusting the nose tip and nose bridge and increasing the height.
Improving the shape of the nose tip: The previously blunt nose tip became more sophisticated and natural-looking.
Improving the symmetry and form of the nostrils: Correction to achieve a more balanced appearance.
Naturally adjusting the nasolabial angle: A more harmonious appearance between the nose and the lips.
I would like to give some advice to those considering rhinoplasty surgery:
It is essential to consult with an expert. In order for a doctor to choose the most appropiate and safe surgical method that fits each individual, the doctor must posses abundant expertise.
Especially in cases like this one that had previously used a silicone implant for rhinoplasty, it is important to check the location of the implant, since if correction is required, it is important to determine a safe method to correct.
It is importnat to have realistic expectations about the surgical results. Rather than looking for perfect results, it is recommended to aim for a natural result that fits the patient’s own features well.
I wish everyone health and beautiful rhinoplasty results.
Noselab Rhinoplasty Clinic
Dr. Chayoung Kang.
Comments