[Contracted Nose] Deep Analysis of the 5 Steps of Contracted Nose Correction Part 02_Separation of the Cartilage Structure and Relocation to the Correct Position

Hello,

This is April 31 Plastic Surgery.

Today, following from last time, we’ll talk about Step 2 of contracted nose correction surgery: Separation of the cartilage structure and relocation to the correct position.

Changes in the Cartilage Structure Due to Contracture

Deep Analysis of the 5 Steps of Contracted Nose Correction Part 02

When contracture progresses in the nose, the cartilage structure of the nose shrinks and gradually becomes distorted.

The cartilage of the nose is broadly divided into three parts.

The alar cartilage, which forms the movable part of the nasal tip,

The upper lateral cartilage attached just above it and supporting both sides of the nose,

And the septal cartilage, which supports the center of the nose.

As contracture progresses, scar tissue forms in the areas connecting these cartilages, causing narrowing and distortion, and they may melt or develop defects.

The appearance may change severely, but the inside of the nose also becomes narrower, which can make breathing difficult.

The Parts Restored Through Dissection

Deep Analysis of the 5 Steps of Contracted Nose Correction Part 02

This is the process of thoroughly and carefully dissecting between the cartilages, moving the cartilage structure as close as possible to its original position, and preparing it to be fixed in the correct shape.

During this process, cartilage that has been pulled into the nostril may be brought back out, and thickened scar tissue may also be removed.

If a defect occurs in the tissue inside the nostril during the process, a composite graft procedure must be performed so that the cartilage defect and the defect in the inner wall are corrected at the same time.

The more thorough and complete the release, the better the prognosis of contracted nose correction surgery.

The Reason for Complete and Slightly Overcorrection by Release

Deep Analysis of the 5 Steps of Contracted Nose Correction Part 02

The reason we are so focused on releasing this cartilage structure is because of 'recurrence of contracture.'

If the tissue is released and opened up, that space will fill with scar tissue again.

Other tissue may be grafted to replace it, but it is inefficient to refill all of the released areas with other tissue again.

Therefore, except for the main fixation area that will be secured in the new position, the other released areas must be guided to form stable secondary healing so that the new position is maintained well.

The Enemy of Recurrent Contracted Nose: 'Tension'

Deep Analysis of the 5 Steps of Contracted Nose Correction Part 02

The biggest reason scar tissue becomes inflamed, that is, hardens, is when too much 'tension' is placed on it.

If the release is insufficient, it may be forcibly stretched right away so that the shape looks acceptable, but if tension remains like a rubber band, scar formation increases and it becomes very hard.

This soon leads to recurrent contracture, which is why it must be released slightly more than enough, with no tension at all.

What Is a Scar-Cartilage Complex?

Deep Analysis of the 5 Steps of Contracted Nose Correction Part 02

In cases of very severe contracted nose, the cartilage structure may not be clearly exposed.

This applies to cases where cartilage was partially lost in the previous surgery or where scar formation is very severe and repetitive due to multiple factors.

Unlike the contracted noses of the past, which were treated simply with implants, most patients with contracted noses today have already undergone cartilage surgery multiple times.

Because of cartilage damage and changes in the grafted structure, the existing cartilage is already damaged or missing, and there may also be unidentified grafted tissues. These are connected to and covered by scar tissue.

If you try to dissect these areas to find the original cartilage structure, you may cause even more severe damage.

After first dissecting the skin flap thinly and evenly, the scar and cartilage structure underneath should be viewed as a single complex and dissected together.

After dissecting it that way, moving and fixing it into a symmetrical and correct position, the cartilage-scar complex is then refined into an appropriate shape.

In the correction process for contracture, proper dissection of the cartilage structure is a very important step, not only for aesthetic restoration but also for functional restoration.

As contracture progresses, the appearance becomes severely distorted, but functional loss or weakness, whether minor or major, will also occur.

Since distortion of the cartilage structure of the nose changes the airflow path inside the nostrils, this also affects function.

Understanding the dissection of the cartilage structure is very important, not only because it expands the goal of correction to include functional aspects as well as appearance.