the plus rhinoplasty

Correction of Failed Rhinoplasty

Sometimes, patients may express dissatisfaction or continual discomfort due to minor issues that arise post-surgery, aside from serious complications. If these concerns are addressed promptly and effectively, it can restore patient trust and satisfaction. However, if these issues are unattended or delayed, the problems can escalate. Situations where a patient’s previous surgery requires supplementation or a second operation are typically referred to as revisions.

Cases that Require Nose Revision Surgery

Case 1: Displacement of the Implant

Displacement (deviation) of the nasal bridge is a common phenomenon after nose surgery. The displacement of the implant itself is more frequent in cases where silicone is used compared to other implants. This is because, over time, the bilateral capsules form asymmetrically, or the phenomenon of implant migration is more common than other implants. Initially, after surgery, one side of the capsule can be expanded and corrected using the endonasal approach. However, if it recurs, an open approach must be used to create a new pocket for the implant.

Causes of Displacement (Deviation) of the Nasal Bridge Implant

① Malposition due to improper separation of the periosteal space during surgery.
② Incomplete correction of the asymmetry of the nasal bone under the implant during surgery.
③ Asymmetrical formation of the initial capsule due to hematoma, seroma, etc.
④ When the bottom of the implant and the nasal bridge do not harmonize during surgery.
⑤ Asymmetric use of facial muscles from a long-term perspective.
⑥ Deformation due to personal habits (habitual touching or shaking).

Case 2: Reduction of Nasal Apex Protrusion

Reduction in nasal tip protrusion is a common cause of dissatisfaction after surgery. Some patients complain that the height of the tip of their nose has decreased after surgery. Therefore, corrections can be made according to each cause.

Causes of Loss of Nasal Apex Protrusion

① A subjective phenomenon where the swelling completely subsides a few months after surgery and the height of the tip of the nose feels lowered.
② When the graft for nasal apex protrusion is actually absorbed (graft absorption).
③ Strut strength is compromised in implants used for actual nasal apex protrusion.
④ Lowering of the tip of the nose due to repetitive facial muscle movements

Before	After

Case 3: Excessive Nasal Apex Protrusion

Although this is a rare problem in Asian rhinoplasty, it should not be overlooked. In cases where excessive nasal apex implantation or severe nasal apex protrusion is created after surgery, it can be easily corrected using an endonasal approach. However, if the columellar support is set high or the septal extension graft is too excessive, creating an exaggerated nasal apex protrusion, it is difficult to correct with this method and the underlying cause must be corrected using an open approach.

Causes of Excessive Nasal Apex Protrusion

① When the tip of the nose is rotated too far to the two sides (over-rotated tip)
② When excessive nasal tip transplantation is performed
③ When the columellar support or septal graft is too high
④ When the cinching suture is excessively performed during nasal tip lowering surgery
⑤ When the nasal tip graft is excessively performed or when the nose length is made too short for nose correction.

Case 4: Correction of Nasal Wing Asymmetry

Asymmetry in the nasal wing can be caused by an uneven nasal septum or nasal wing cartilage. This can be corrected by adjusting the nasal septum or the nasal wing cartilage.

Here is a case of nasal wing deformity correction. The images show the patient 1) before surgery, 2) two weeks after surgery, and 3) two months after a re-correction procedure. The re-correction was performed using a simple autologous cartilage graft via an endonasal approach, three months after the initial surgery.

See more before and after surgery photos.

Case 5: Various Corrections of Minor Tip Deformity

A) Correction of Pinched Tip
A pinched tip that occurs after surgery can be corrected by lowering or loosening the excessively gathered or raised tip cartilage. If the pinched tip occurred without excessive manipulation, it indicates that the alar cartilage is weak. In such cases, the alar cartilage is strengthened through ear cartilage grafting.

B) Correction of the Nose Tip where the Graft is Visible
The most common method for nose correction supplements the patient’s own tissue or homografts using a closed approach. However, in some instances, patients may require a comprehensive correction using an open approach. It’s critical to be aware that using fillers or fat grafting for the correction of the nose tip can pose significant risks.

A common issue that we address is the recurrence of a bulbous nose tip. As previously explained, there are instances where the nose tip reverts to its original state after surgery. This can be attributed to the patient’s skin condition and the degree of scar tissue formation. Generally, the cause can be traced to two main factors. First, patients with originally thick and tough nasal skin may initially present satisfactory post-surgical results, but the tip of the nose may enlarge again after about six months. Second, there are cases where excessive internal nasal scars form due to previous surgeries, such as those involving the use of a sheath for the implant. In these situations, it’s vital that both the surgeon and the patient understand the potential limitations of the surgical outcomes.

Above is a case study of a patient who had multiple surgeries at other hospitals and visited us with a bulbous nose. The images show the patient’s nose 1) before surgery, 2) one year and six months after surgery, and 3) about 4 months after re-correction.