Rhinoplasty Korea

Diced cartilage in fascia was used in silicone-related contracted nose patient. She had a silicone implant on the nose and the tip was up-rotated due to contracture. Her nose looked short and the tip was upturned. Silicone was removed from the dorsum and the deficient dorsum was filled with diced rib cartilage in temporalis fascia. Her tip was elongated using septal extension graft and tip grafts. After surgery, her dorsum looks natural and the tip was refined with optimal lengthening.

Silicone is the most widely used alloplastic implant for dorsal augmentation. Gore-Tex, an expanded polytetrafuoroethylene, is also a commonly used material. Unlike silicone implant, Gore-Tex is soft and feels natural. It has micropores, so tissue grows inside and the implant is fixed to the tissue. While Gore-Tex has many advantages, its disadvantages are also distinct. Firstly, it can erode nasal bone a little when the implantation duration is long. Erosion causes pain and heaviness on the dorsum. It is common to see a 'rail road deformity' after longstanding Gore-Tex removal. 'railroad deformity of the dorsum after Gore-Tex removal' Second, it is more difficult to remove than silicone implant. Because tissue grows inside the micropores, it adheres to the tissue. If the implant is inserted deep to the radix, sometimes complete removal is extremely difficult. In this case, endoscopic observation of the nasofronta area helps to completely remove the silicone piec...

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,...

This lady has deviated silicone implant and associated short, contracted nose. It is a very common complication of silicone implant rhinoplasty. Revision rhinoplasty included silicone removal, replacing the silicone with rib cartilage, and lengthening the nose and tip. Only autogenous materials like rib cartilage can enable all these procedures. Filling the empty, excavated dorsum with carved rib cartilage requires a lot of efforts. Tedious carving to prevent warping, secure fixation of the graft to the widely dissected dorsum, making a smooth transition from forehead to nose, prevention of an operated look, etc. Lengthening the contracted skin needs wide undermining of skin, making a stable flatform to fix the lengthened tip cartilage and skin, and filling the deficient vestibular skin if present. Behind the 3 series of pre and postoperative photos below lie 4 hours of focused efforts of a rhinoplasty surgeon.