Replacing silicone with rib cartilage

Removing deviated, problematic silicone implant and immediately replacing it with autolgous rib cartilage is a difficult job but it is worth trying. After removal of either deviated or protruding silicone implant, the dorsum is even more depressed than preoperative status. It is because the skin is thinned due to long-term stretching and the bony/cartilaginous dorsum is slightly resorbed due to pressure of silicone. After removing the silicone, the dorsum is closely observed and any irregularities or deviation of the dorsum is corrected if present before rib cartilage graft.

Rib cartilage, harvested from the chest, is carefully carved without hurry. It is carved into a canoe shape so that the forehead to nose and face to nose transitions are smooth. Warping is prevented by using the central core portion and careful symmetric carving. Secure fixation of the rib cartilage to the dosrum is also important. Suture fixation, grafting perichondrium on the undersurface of the radix portion, and even K-wiring help to stabilize the graft.

It usually takes more than 3 hours when revising silicone implanted nose. However, these efforts are reward with the natural looking nose with no danger of alloplast related complications.

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Deviated & hump nose correction

This lady in below photos had nasal deviation, hump nose, and tip ptosis with breathing difficulty. Septum was corrected first, and this made the lower 2/3 of the nose straight. Hump was not resected but rasped with Piezotome and this did not breach the keystone area, which made spreader grafts unnecessary.Bilateral osteotomies with Piezotome made her bone straight. Together with septum correction and effective osteotomies, her nose became straight from the frontal view. Tip was modified with sutures and onlay graft only. No strut or septal extension graft was used and this made the tip soft even after considerable amount of rotation and projection increase. Radix was augmented with bruised cartilage. Overall, she could breath much better after surgery and her nose became more harmonious and feminine.

key to rib cartilage use in rhinoplasty

I had the joy to guest edit a special issue ' The key to costal cartilage in rhinoplasty' in journal 'Plastic and Aesthetic Research'. This special issue covers all issues of rib cartilage use in rhinoplasty; cutting edge techniques of harvesting and carving, application of rib cartilage in primary and revision rhinoplasty, practical points for proper preoperative and postoperative care, and diced cartilage and homologous cartilage applications. I invited world renowned rhinoplasty surgeons who are specialists in dealing with rib cartilage use. I hope rhinoplasty surgeons who wants to use rib cartilage in their practice will benefit from the wisdom of the experts.

Creating more feminine nose

The lady in below photos visited my clinic for rhinoplasty. She wanted to have more feminine nose instead of her muscline nose. She had a long nose with slight bump on the dorsum, overprojected, slightly bulbous and droopy tip, and slighly wide dorsum. Surgery was focused on creating more feminine look: hump removal, narrowing the bony dorsum with osteotomies, tip volume reduction, decreasing tip projection, and slight cephalic rotation. Photos taken 2 weeks after surgery (because she returnd back to her country after surgery) shows changes on the dorsum and the tip. Dorsum became slender with creation of smooth brow-tip aesthetic line. Tip was refined with volume reduction, slight underprojection, and cephalic rotation. Although the changes are not radical, her nose looks more feminine.

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