[Rari Plastic Surgery] Autologous Rib Nose Revision Surgery Combined with Cat Surgery and Philtrum Reduction Surgery (+ Permanent Nasal Bridge Filler Removal)

Recently, many people have already undergone rhinoplasty several times,

or are considering revision surgery because filler or implants led to unsatisfactory results.

In particular, if there is still a lump of previously injected filler,

or if the nasal tip has drooped or the nasal bridge line has become distorted,

then it is not enough to simply replace the implant.

A revision rhinoplasty strategy that rebuilds the nasal support structure is needed.

In today’s case, a patient had a lump of permanent filler (calcium filler) previously injected into the nasal bridge removed, then had the silicone implant replaced,

and the nasal bridge and tip were firmly lifted again using autologous rib cartilage.

At the same time, a lip remodeling procedure was performed to create balance in the mouth area by combining cat surgery with philtrum reduction surgery.

As you can see in the photo, although the patient had already undergone rhinoplasty, they were dissatisfied and received filler in the nasal bridge,

leaving filler remnants and fibrotic tissue inside the nose that bulged out like a lump along the bridge.

Because of this filler, the nasal bridge does not look smooth and also appears crooked.

If the filler injected previously was hyaluronic acid filler, some of it can be dissolved, but in the case of calcium filler like this, it is not absorbed and cannot be dissolved.

So if revision surgery is performed in this state,

the nose must be opened and all remaining filler scraped out before proceeding.

After carefully removing the bulging filler mass on the nasal bridge,

we checked the bridge and confirmed that a thin silicone implant had been inserted, contrary to what was desired.

So the existing silicone was removed and a new silicone implant of the desired height was reinserted to match the nasal bone line.

Through this process, the nasal bridge line that had looked uneven and bulging between the eyes before surgery

changed after surgery into a much smoother and more three-dimensional overall line.

After filler removal and silicone replacement, an appropriate support structure must be selected to refine the nasal tip.

Because this was also a revision surgery and the patient wanted a high, striking nose from the bridge to the tip,

autologous rib cartilage was chosen instead of ear cartilage or septal cartilage as the support material.

The reason is that to raise the nasal tip high, it is important to build a strong support structure, and rib cartilage offers superior strength and support compared to other cartilages for that role.

(Details about autologous rib cartilage can be found in the post below)

Looking at the nostrils and columella before and after surgery,

as the nasal tip became higher, the rounded nostril shape before surgery became more elongated and straight,

and you can clearly see the raised, refined nasal tip and the well-centered columella shape.

Looking from the side, you can see the angle between the philtrum and the nasal tip.

This angle is called the nasolabial angle,

and if the nasolabial angle is too narrow, the mouth may appear protruded even if the bone structure is not actually protruding.

Cat surgery can widen the nasolabial angle to create a more dimensional area beneath the nose,

and naturally improve the appearance of a protruding mouth.

Because cat surgery is performed by pulling the nasal tip upward to widen the nasolabial angle,

people with a slightly long philtrum may feel that the philtrum becomes even longer after cat surgery.

That is why, when philtrum reduction surgery is performed together,

the actual length of the philtrum is reduced, so even after cat surgery there is no feeling that the philtrum has become longer,

and the line connecting the nasal bridge, nasal tip, philtrum, and lips becomes smooth and refined.

In other words, by correcting both the angle and the length together, the proportions of the central face are harmonized.

Because the two areas are anatomically adjacent,

it is easy to perform them at the same time, and it is also efficient for recovery and swelling management.

The nose is the center of the face and an important area that influences the overall impression.

If the current state is unsatisfactory due to a previous surgery or filler procedure,

you should consider revision surgery to accurately correct the cause of the dissatisfaction.

As in this case, the combination of revision rhinoplasty using autologous rib cartilage, cat surgery, and philtrum reduction surgery

can be a very effective surgical combination because it improves the balance from the nasal bridge to the nasal tip and even the lip line in a comprehensive way.

However, as with all surgeries,

it is important to fully discuss what you want and choose a doctor who can accurately reflect it.

Nose surgery especially requires careful postoperative recovery management,

so it is best to stay in regular communication with the clinic after surgery until the nose settles well.