I'll write down the things I've felt over the past while. Looking at the topics everyone is most curious about, it seems a lot of the questions I worried about most have been posted. First of all. I'll talk about bulbous noses. You all know that the more you keep touching the nose, the more scar tissue forms, which is not good. Usually, hard contracture inside the collagen starts around 2 weeks and can continue for as long as 1 year. If the nose is large, the alar cartilage is underdeveloped, or the nasal tip skin is thick, it can take up to 1 year. People with thick nasal tip skin should really think carefully. For example, if you touch the skin around your elbow, it's very thin, right? If you have a dorsal hump nose, the skin over the glabella hump area will be very thin. The reason is that over decades of growth, the bone has been pressing on the skin, so the skin gradually becomes thinner. The same applies to the nasal tip skin. If the alar cartilage (I'll use this to mean the bone at the tip of the nose) is small, there will be less pressure on the skin at the tip, right? Then the nasal tip skin is thin in Western people whose alar cartilage is well developed (in many Western people, you can already see the alar cartilage just by looking at the tip of the nose). So there are people whose nasal tip skin is thin and whose alar cartilage itself is small, but there are also people whose alar cartilage itself is underdeveloped, making the nose skin thick. Because of this, the final swelling and shape result of the nose can take 3 months for some people, 6 months for others, and 1 to 2 years for yet others. As I wrote above, silicone showing through or ear cartilage showing through happens because over years or a long period, the silicone or ear cartilage presses on the skin, making it gradually thinner until it shows through. Therefore, for people whose skin is showing through, there are cases where dermal grafts, fascia, and similar materials are used to reinforce skin thickness while also inserting an implant. In conclusion, for people who need revision surgery because of visibility problems, either remove it decisively or just live with it. In the end, even if time passes, the skin gets thinner and shows through. 2. Why repeated revision surgery or removal can make the nose bigger The nose can be divided into four parts. 1. Nasal bone - 2. Septum - 3. Dorsal nasal skin - 4. Nasal tip (up to the columella) (see photo) Here, number 3, the skin over the nasal bridge, is the thickest among the nose's skin. For example, let's say the implant was removed. Scar tissue (empty space) fills in up to numbers 1, 2, and 3. Everything from 1 to 4 gets pulled tight. Then number 4 becomes shorter, and the pulled skin from number 3 becomes the thickest, right?? The most decisive factor in whether a person's nose is small or big is number 3, the dorsal nasal skin. If this area is wide or protrudes forward (that is, is high), the nose is called big. A representative example is Ms. Lee Pani. If the number 3 dorsal skin has spread sideways, the alar cartilage can be repositioned at the tip and the tip cartilage can be sutured together to bring it in (to a certain extent). But if the dorsal skin is high upward, it cannot be reduced. Even if you gather and reduce the lateral cartilage, if the skin itself is thick, you can only reduce it sideways, not forward. In other words, if the skin in number 3 is high, the nose cannot be reduced much. If contracture or scar tissue forms after revision surgery, number 3 skin becomes thicker or an empty space (dead space) forms, so if this area increases, the nose becomes very large. To prevent this, there are various methods such as massage with Retin-A, etc. But from my experience, after repeated removal and revision surgery, I thought at one point that massage was helping because contracture loosened quickly during removal, but after repeating it many times, there was not much difference compared with not massaging (it was just a feeling, the nose skin temporarily became softer). Once you start touching the nose, you end up developing the habit of touching it 계속, etc. To summarize the reasons for a bulbous nose and a big nose, it is like this. If the skin on dorsal area number 3 is high forward (from the side, the area below the nasal bone is high) or spread outward, the nose looks bigger. Most people may feel that the nose is big because number 4, the nasal tip, is large, but number 3 is the key to a bulbous nose. Number 4 only affects the side view of the tip. And let me talk about a crooked nose. For the nose to look straight, the line between the eyebrows and the philtrum line should align in a straight vertical line. What does that mean... Nasal bone - septum - dorsal nasal skin (the thickness on the left and right is often different) - nasal tip alar cartilage (often not symmetrical) For most people, there are not many whose line from the glabella down to the lips is perfectly straight. That's because the facial axis is twisted. (Most people don't know this. A mirror is when you see yourself, but when someone else sees you, the left and right are reversed. Selfies are mirror mode; when others see me, it's a photo taken by someone else. You can check by looking at a photo taken by someone else or a hospital photo.) Then the question is whether you align the center line from the glabella to the nasal tip, or whether you align the glabella separately and the nasal tip separately with the lip line. Let's say you align it to the glabella. If the part connecting the maxilla and the nasal bone is twisted to the left or right, the nasal tip will twist along with it. Even if the septum is set straight, it may improve, but if it is, for example, C-shaped and bent, it will only straighten a little, not into a perfect vertical line. Because it recurs. In conclusion, foreign people's noses are all crooked. If the nose is high, too small, or narrow, the crookedness stands out more. If the nose is wide, large, or low, the crookedness is not noticeable. Most people have some degree of crookedness, and the reason the nostrils are uneven is that before surgery the nose was compressed (the nostrils lay down), so once it is stood up, the nasal axis often looks like it is collapsing... If they are still uneven after removal, it may be because during an open approach the nasal skin was pulled up, or the septum is crooked, or for various other probabilistic reasons. In conclusion, if only the nose is crooked, surgery that corrects the nasal bone, septum, and tip together has a high chance of improvement. If the axis itself is crooked, instead of making the nose much taller, it is better to raise it moderately, or if you make the nose too narrow, it can look even bigger. (Black people often have crooked noses but it does not show at all, whereas it is especially noticeable in Western people.) Lastly, about material questions Septal cartilage, costal cartilage, Medpor, ear cartilage Silicone, Gore-Tex Rather than saying all materials are simply good or bad, if you want to pull the skin in number 3 downward, the strongest support is effective, but that depends on the surgeon's skill. In other words, surgeons who use ear cartilage well probably have their own know-how. In my opinion, costal cartilage is a last-resort material and an aggressive method, because when you place a final support structure (insert a support between the alar cartilages), the lower cartilage bridge area is worn down and gradually thins, so after removal it may collapse. The same goes for Medpor (no need to say more). If the skin in number 3 is severely thick, costal cartilage is probably the most effective, but you have to accept the consequences afterward. Patient satisfaction is the outcome after cosmetic surgery (the shape), so doctors inevitably feel tempted to use supports like Medpor or costal cartilage, and if used appropriately, I think it is not bad (Medpor is a no-no). If you want to do it as safely as possible, for example, if it is a short nose: First surgery Tip cartilage with ear cartilage + cartilage repositioning + no support Second Tip cartilage (ear/septal) + cartilage repositioning + septal support Third Tip cartilage (ear/septal) + cartilage repositioning + costal cartilage support The most certain aggressive way to reduce it Tip (ear/septal) + cartilage repositioning + costal cartilage support + alar reduction That's all....
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