Doctor's Column

Revision Tip Rhinoplasty, which material is safe to use? In the past, artificial materials such as silicone, Medpor®, and mesh were commonly used. However, with side effects now being reported among revision surgery patients, a shift toward autologous human-derived materials is being emphasized. Through numerous revision cases, Dr. Seong-hoon Kim, Director of SH Plastic Surgery, has concluded that "artificial materials should no longer be used for the nasal tip." In this article, we will point out the problems with silicone, Medpor, and mesh, compare the pros and cons of human-derived materials, including autologous rib cartilage, and delve deeply into why the choice of material is the key that changes everything in revision surgery.

Face Designer, Dr. Sung-Hoon Kim, Director of SH Plastic Surgery

Hello. I am Dr. Seong-hoon Kim, facial designer and Director of SH Plastic Surgery.

I can feel the tip of my nose getting cold in the morning.

Lately, it feels as if winter has suddenly arrived, leaving no trace of autumn.

When exposed to such cold air, more and more patients complain of pain, with their nasal tips containing implants turning red first.

Sure enough, one afternoon recently, a woman in her 30s carefully lowered her mask and asked:

"Doctor, can't I just take this out...?"

The tip of her nose was red and swollen, and the edge of the silicone was pushing up against the thinned skin.

She said she had been satisfied at the time of her surgery seven years ago, but over the past few months, it had strangely started to lift,

the nasal tip became sensitive, and it even became visible in the mirror.

She mentioned that it tingled whenever she touched it, and that the tip of her nose frequently turned red as if she had caught a cold.

Upon examination, the skin had thinned from the pressure of the silicone,

and the cartilage tissue had atrophied, causing the nasal tip to gradually collapse.

It was on the verge of inflammation, and any further delay could have resulted in skin perforation.

Removing it in this situation was a given,

and the most important question I ask myself is this:

"After removing this, how do we rebuild it?"

It does not end with simply removing it.

Once a structure has collapsed, it must be redesigned,

and a "material" that will not collapse again must be selected.

In this article today,

I would like to talk about the criteria and direction for that "material selection."

Artificial Materials vs. Autologous Tissue: The Choice of Material Changes the Surgical Outcome

In the past, artificial materials such as silicone, Medpor®, and mesh were widely used as rhinoplasty materials to quickly shape the nose.

However...

There are problems with artificial materials.

In the end, while artificial materials may be convenient in the short term,

the human body cannot overcome them over time.

Conflict with tissues, inflammation, contracture, and skin damage are not a matter of "if they will occur," but merely "when they will occur."

That is why I always emphasize that for the tip of the nose, at least,

the surgery must be performed using human-derived materials that the body can accept naturally.

Order of Priority and Criteria for Selecting Autologous Tissue-Based Materials

In revision surgeries, stronger materials that resist deformation are even more essential. Human-derived autologous materials are not absorbed and integrate seamlessly with one's own tissues, offering far greater stability and long-term durability.

Below are the materials I recommend:

Autologous Costal Cartilage (Rib Cartilage) – Highest strength, exceptional structural support

Donated Costal Cartilage – No harvesting scar, reduced cost, slightly higher absorption rate

Autologous Septal Cartilage – Can be harvested internally, good elasticity, but limited in quantity

Autologous Ear Cartilage – Soft and natural, but has limitations in providing structural support

Why is Autologous Costal Cartilage the Top Priority?

"Costal cartilage? You mean removing a rib? Isn't that dangerous?"

Many patients ask this, but in reality, it can be harvested safely according to the following standards:

Use of the 6th–7th costal cartilage: For women, the scar is concealed beneath the inframammary fold.

Partial harvesting technique: Because the entire rib is not removed, post-operative pain is significantly less.

Support and shape retention: Its rigid structure firmly supports the nasal tip with virtually no absorption.

Above all, because it is "material sourced from your own body," the risks of inflammation, foreign body reactions, and capsular contracture are minimized.

"Where will the scar be left?"

This is one of the questions patients ask most frequently regarding costal cartilage surgery.

Since preferred harvesting sites differ among surgeons, the location of the incision line can also vary slightly.

Personally, I tend to prefer the 6th and 7th costal cartilages.

Therefore, in female patients, the incision is typically made along the inframammary fold, beneath the bra line.

This offers the advantage that the scar remains invisible unless undergarments are removed, and it is not exposed even when wearing a bikini in the summer.

In male patients, on the other hand, the scar is inevitably somewhat more noticeable.

Because of this, harvesting is sometimes performed from the 8th or 9th costal cartilage whenever feasible.

This shifts the incision line slightly away from the midline of the body, making it visible only subtly from the side rather than the front.

During surgery, scars are designed meticulously along the skin tension lines to be as small and inconspicuous as possible.

However, the harvesting location and orientation depend on individual body shape and skin condition,

as well as the surgical plan, so these are thoroughly explained and decided during consultation.

Why Partial Harvesting is More Advantageous than Complete Harvesting

Additionally, there is another key point I prioritize when harvesting costal cartilage.

The point is that we prioritize "partial harvesting" whenever possible.

Many people commonly believe that rib cartilage is removed as an entire, whole piece,

but in fact, if it is completely harvested like that, it can cause pain every time you breathe.

This is because our chest cavity moves every time our body breathes.

As the chest cavity expands when inhaling and narrows when exhaling,

the rib cartilage area continuously repeats expansion and contraction.

Therefore, every time you breathe

and every time you move, irritation is applied, leading to a sharp, tingling pain.

That is why I harvest the cartilage using a "partial harvesting" method whenever possible.

It involves resecting only as much as needed and preserving the continuity of the rib cartilage as much as possible.

By doing this, there is less irritation even when the chest cavity moves,

resulting in far less pain and a faster return to daily life.

Surgery is not finished just because the tip of the nose becomes pretty.

Considering the patient's recovery process and daily life—that is the true core of surgical design.

These small differences ultimately make a difference in the overall outcome.

Considerations by Director Kim Sung-hoon

What I felt most acutely while performing countless revision surgeries is the fact that "the choice of material determines the fate of the surgery."

Revision surgery is much more demanding than the first surgery. This is because scar tissue, thinned skin, and asymmetry remain where artificial implants have been removed.

In such situations, autologous rib cartilage is the only material that is strong, does not get absorbed, and is well-accepted by the human body.

I believe that no matter the surgery, one must capture both aesthetics and function.

A nose that maintains its shape even after a long time and is comfortable without inflammation.

That is the true purpose of the surgery,

and autologous rib cartilage is the material that best realizes that philosophy.

FAQ

Q. Isn't harvesting rib cartilage dangerous?

→ Partial harvesting alone is sufficient, and scars are mostly concealed by underwear.

Q. Isn't it obvious because the rib cartilage is stiff?

→ It can be shaped into natural curves by designing it together with soft ear cartilage.

Q. Is donated rib cartilage safe?

→ It is safe due to sterilization processing, but there may be differences in the absorption rate.

Q. Is immediate revision surgery possible right after silicone removal?

→ It depends on the condition of the tissue; if there is no inflammation, immediate reconstruction is possible.

Q. Is it possible even if the tip of the nose has become thin?

→ Depending on the case, it can be restored by using supplementary materials such as the dermis or fascia.

Q. Can autologous rib cartilage continue to be used in revision surgery?

→ It can be used repeatedly if there is a sufficient amount. However, the structural design is more important.

(17) #Why is revision rhinoplasty necessary? Are there any precautions? Everything about revision rhinoplasty! [feat. Dr. Seong-Hoon Kim, SH Plastic Surgery] - YouTube

SH Plastic Surgery Clinic