[Contracted Nose] Deep Analysis of the 5-Step Contracted Nose Correction Surgery Part 01_ Sufficient Dissection and Release

Hello.

This is April 31 Plastic Surgery.

Following last time, we would like to talk about contracted nose correction.

A contracted nose is a surgery that requires very delicate and highly advanced technical skill, and we will explain the contracted nose procedure in detail in five stages.

Today, we will explain the first of the five stages: adequate dissection and release of the skin layer.

To correct a contracted nose, first an open incision must be made and the skin flap lifted.

A contracted nose refers to a nose structure in which the tissue has shrunk, become distorted, and shortened. Because the cartilage tissue underneath is tangled, bent, and contracted, there must be enough width and length in the skin layer that covers it in order to stretch or raise it back to its original normal position.

However, because the skin layer is already filled with scar tissue, it has become very tough and extremely stiff, so it does not stretch easily.

To stretch it as much as possible, dissection must be performed under four conditions.

1. Thin dissection
2. Uniform dissection
3. Wide dissection
4. Dissection that maintains normal blood circulation

When these requirements are met, the skin layer gains as much room as possible to stretch. In contracted nose correction, skin dissection is technically a very difficult and important process.

April 31 Plastic Surgery Contracted Nose Correction Surgery

Q. It has been one year since implant removal due to inflammation. My nose has become much shorter, and the skin is still stiff. Can the skin stretch?

A. In most cases, about one year after implant removal, the scar tissue softens. However, sometimes when you touch it, the nose still feels stiff, as if the scar has not loosened.

In some cases, the loosened scar is thick, so it feels stiff to the touch, and in other cases, the scar has not actually loosened, so it feels stiff to the touch.

Even in these cases, if the dissection is done well, the skin layer can still stretch. But when that is not enough, other methods may be additionally performed. For example, among safe autologous tissues, soft dermal-fat tissue or fascial tissue, such as buttock dermis, may be inserted.

These tissues replace the skin and scar tissue and, after several months, help soften the stiff and tough skin.

The reason dermal-fat or fascia is grafted in contracted nose cases is that it can serve as supportive tissue that can withstand stretching by the skin and help prevent circulatory problems.

In addition, because it increases volume in the shortened and contracted nose, it also has the advantage of improving the shape.

In the skin dissection process for a contracted nose, the skin is dissected very thinly, so highly skilled technique is extremely important. How thin and how well the flap can be made to stretch has a major effect on the surgical outcome.

Q. It has been 2 years since my contracted nose was corrected with autologous tissue. Can I get a nasal bridge filler in the glabella area?

If the contracted nose was corrected completely with autologous tissue, there would be no implant in the nasal bridge area, and it would likely have been corrected with autologous dermis or fascia.

Contracted noses are concentrated in the lower third to half of the nasal tip area, and if you want revision or supplementation in the glabella area rather than the tip, it may be considered a case in which the surgery was done well.

Recent filler products are diverse and very safe.

When correcting a contracted nose, if you only want to raise the bridge, getting filler in the glabella area is acceptable.

However, tip filler can be very dangerous.

The nasal tip area has already undergone several surgeries, and there is a large amount of graft material in place.

After surgery, the blood circulation structure of the nasal tip has changed to an indirect vascular structure.

To explain in detail, the visible vascular structure has already been cut off, disappeared, and been destroyed, and during various processes such as inflammation or surgery, microscopic vessels from the surrounding area have grown in as an emergency, indirect blood supply to maintain skin circulation.

※Why nasal tip filler should not be used after contracted nose correction※

If filler compresses the newly grown microvessels, the likelihood of skin necrosis is high, so it is very dangerous and not recommended.

What if there are irregularities in the scar in a severe contracted nose?

In severe cases of contracted nose, the scar may protrude or become depressed. The protruding area may have risen up or may have become established as a scar.

If the skin is dissected too thinly, there is a high chance of making a hole in that area. At this time, the skin dissection in the area with irregularities is done with a slightly different layer thickness.

The depressed area is hard because of scar tissue. That area is made slightly thinner, and dissection may be performed in a double plane.

In depressed areas, cartilage or other autologous tissue may be grafted directly underneath to expand the area and correct it.

These processes are very complex and do not heal all at once, so, as in scar surgery, we sometimes perform surgery in which we directly make an incision and suture it.

At April 31 Plastic Surgery, contracted nose surgery is sometimes performed in two stages.

Some people feel burdened by having surgery multiple times.

However, once a nose has become contracted, if you rush to complete everything at once, it can actually lead to worse results.

The reason contracted nose surgery is sometimes done in multiple stages is that there are many small procedures needed to improve the contours of the skin area.

Skin-layer dissection, as the first step of correction surgery, is important not only for a successful operation but also for minimizing the range and number of revision procedures needed later to create a normal nose.

When correcting a contracted nose, because it cannot be completed in a single step, rapport between the medical team and the patient is important. If you understand these processes, I think you will feel a little more hopeful.

Next time, we will talk in detail about the second stage of contracted nose correction.