Hello.
In general, I think many of you are probably afraid of removing silicone after nose surgery.
I also had it removed.
First, I’ll explain how the nose shape may look afterward depending on the surgical method used for removal.
1. Bridge
When an implant is placed in the nasal bridge during rhinoplasty, regardless of the surgical method, the cornered, roof-like part of the nose is ground down like this.
As shown in the second photo, the roof opens up.
No one can avoid shaving down the bridge area when an implant is inserted.
The reason is that in most people the nasal bone area has cornered, roof-like edges like △.
If silicone were inserted in that state, it would shake very severely, could not even be fixed in place, and the risk of hematoma forming while the silicone is floating, leading to inflammation, would be very high.
Because of that, if you simply pull the silicone out,
the bridge will look very wide.
In fact, that roof is there, and the difference is not just a problem with the nose itself,
but the face can look broader and more spread out.
So what is the solution?
1. Perform double osteotomy on the inner and outer sides, and bring the widened nasal bones inward so they are closer to a △ shape.
The nasal bone roof is restored as before surgery, but due to the lowered nose caused by the process of shaving the bone,
it may look a little wider and lower than before surgery. This is due more to the height of the nose than to its width (because the bone was shaved).
2. This is a relatively less extensive method.
This method shaves both sides of the nasal bone. It is a smaller-scale procedure and is very effective for people whose bridge was already high.
In general, people with a high nose have a narrow bridge width (if you look at foreigners in the extreme case...), so if the nose is osteotomized, the bridge width can become too narrow,
so shaving the bone is the better method.
3. A method to increase height
The most definite option is an artificial implant such as silicone, but from the perspective of someone who has had it removed, of course you do not want to use an artificial implant.
Then what do you fill that area with?
Cartilage? You cannot fill it with ear cartilage or septal cartilage (I’ll explain the reason below).
That is because the amount needed is large. The costal cartilage is cut into pieces and stacked with fascia, or autologous dermis is folded in half and placed on top,
so that a roof is forcibly created on the nasal bone.
This method can both make the widened bridge look narrower and increase height, so in a way it is a two-birds-one-stone effect. But it also has drawbacks.
If the nasal bones were already wide and then shaved down, there are limits to what this method can achieve.
Conclusion
1. Osteotomy = if your bridge was already wide and you are in the process of removing silicone, osteotomy is better.
2. Shaving method = if you had an unnecessary implant placed by an unqualified doctor after having a hump nose originally, then the shaving method is better.
3. Heightening method = this method can be applied to both osteotomy and shaving methods.
In other words, dissatisfaction with the height rather than the width of the bridge is addressed by increasing it.
2. Tip
Usually, when surgery is done,
To put it very broadly and simply,
it comes down to whether there is a support structure at the tip or not.
In other words, except for a small number of hospitals like 101 that use ear cartilage support (about 10 places in Gangnam),
ear cartilage is not used as a support structure.
They simply attach a shield graft or cap graft to the nasal tip.
And costal cartilage and septal cartilage cannot be attached to the tip to make it higher, because they are very strong,
so if they are placed on the tip, the tip can show through very severely, which is why most hospitals use them for support.
This is how the nose looks when viewed from below.
1. In most Koreans, the tip cartilages are spread apart like this (the two circles are the nostrils).
2. Tip cartilage suturing (alar cartilage rearrangement)
3. Tip cartilage suturing (alar cartilage rearrangement) + cartilage graft
4. Tip cartilage suturing (alar cartilage rearrangement) + cartilage graft + support structure
Usually, in cases 2, 3, and 4,
if silicone is removed, the middle of the nose collapses.
The reason is, if you hold the tip with your hand and look at the side profile in the mirror, the middle part of the nose dips, right??
The reason silicone is usually used is not only because the bridge is low, but also because that middle part of the nose dips.
Then if you lower the nose, that dipped middle part of the nose will no longer be dipped, right?
But if you lower the nose, it becomes longer, looks older, and the width of the tip becomes wider again, just like before surgery ㅜㅜ..
If the nose was lifted up, then lowering it is the right thing to do, and if the nasolabial angle at the tip is good,
then you only need to fill the middle part of the nose, right?
That part can be sufficiently filled with ear cartilage or septal cartilage.
For that point, hold your nose with your hand and look in the mirror. The upper point of the tip dips, right? That is the part you need to fill.
1 and 2 are the same. In fact, these two methods are simple.
The issue is whether a support structure is used.
If a support structure is inserted between the tip cartilages, the tip cartilages become thinner. (like shoe soles wearing down)
Then if you simply remove everything, the tip will sag downward and collapse.
To prevent this, the cartilage is sutured and rearranged as well, but there are limits. (This depends on whether to remove everything or leave some behind, depending on the elasticity of the cartilage.)
But why use a support structure in the first place? Simply put, the purpose is to make the leg portion of the alar cartilage (tip cartilage) thicker and stronger.
In the end, if you remove everything,
when you hold the tip with your hand and look at the side profile, an imbalance will arise between the bridge and the tip, specifically between the tip and the upper point of the tip.
Let me summarize.
1. If the bridge itself is low, autologous dermis is better, or costal cartilage pieces with fascia.
The reason is that a large amount must be filled, and it is easy to supplement later (because the remaining dermis after harvesting can be made into an injectable). Additional supplementation is possible by injection without extra surgery.
Costal cartilage pieces and fascia are less ideal than dermis because both dermis and costal cartilage are autologous tissue, so the amount of absorption cannot be predicted 100%.
In addition, to correct even fine irregularities, if dermis injection is prepared in advance as with dermis, there is no need for a second surgery, so I think dermis is better than cutting up costal cartilage and placing it there.
2. If only the upper point of the tip, the middle of the nose, is low
Then you can relatively simply fill only the middle of the nose with ear cartilage, septal cartilage, or AlloDerm, etc.
Even if you hold the nose with your hand and look in the mirror, that range is small, right?
3. If the tip is lifted up
Then simply lowering the nose will not cause the middle of the nose to dip.
In that case, there is no need to insert anything; you just lower the nose.
And whether alar cartilage rearrangement should be done or not,
if it falls under 1 or 2, the nasolabial angle at the tip is fine,
so you can simply fill the middle part of the nose or the whole nose.
If it falls under 3, alar cartilage rearrangement is needed!!
I wrote the post like this for now.
Don’t be scared of removal.
The nose, unlike standard eye or contour surgery, can be restored to its original state whenever needed.
The content above is entirely about skeletal issues (the nasal bone and tip cartilage [alar cartilage]).
Next time, I’ll write about contracture and the capsule (skin).
Nasal surgery results vary depending on skeleton 50% + skin 50%.
And I can’t check messages on my phone at home very well,
so if you have more questions, please message me on KakaoTalk at m0900
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