Doctor's Column

A contracted nose is one of the most severe complications that can occur after rhinoplasty. It is characterized by the nasal bridge becoming hard and pulled upward, the tip curling up (upturned nose), and nostrils being excessively exposed, transforming into a pug-nose shape. Additionally, the columella may sit higher than the alar rim, the nasal tip can become thick and blunt, and the nasal bridge may deviate to one side, deviating from the midline.

Contracted nose revision surgery is closer to reconstruction rather than simple aesthetic restoration. It requires advanced techniques to dissect and remove all scar tissue, capsules, and contracted tissue, lengthen the shortened tissue, and rebuild the nasal framework using human-derived cartilage. In this Doctor's Blog, Dr. Sung-hoon Kim of SH Plastic Surgery explains through an actual contracted nose case why contracture occurs, through what process it can be restored, and which materials and principles are used. This will serve as the most practical guide for those contemplating contracted nose revision, nasal reconstruction, scar tissue removal, rib cartilage-based reconstruction, and columellar lengthening.

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

"As time passes after surgery, my nose keeps curling upward."

The patient who visited the clinic a few months ago was a 29-year-old woman from Thailand.

It was her second visit to Korea, returning specifically because of the rhinoplasty she had received during her first trip.

As soon as she sat in the chair, she shared her story:

"Doctor... as time goes by, my nose keeps getting pulled up.

It was fine at first, but now it looks so awkward when I smile. The tip of my nose feels bunched up and the bridge is crooked."

Looking at her frontal photograph, it was a typical presentation where contracture had already set in.

Thickened **scar tissue** accumulating on the nasal bridge

The bridge deviating to the right from the midline

A thick and blunt nasal tip

The columella positioned higher than the alar rims

An obviously upturned nose appearance

Upon checking her side profile:

The nose had curled up, pulling the nasal tip upward,

and the columella was pushed and retracted higher than the alar rims—a classic sign of contracture.

Anyone could see that her concern was a serious situation.

The patient asked:

"Can a nose like this really be restored?"

What is a Contracted Nose?

Contracture is a phenomenon in which tissues shrink and harden, pulling the nose upward.

Key Causes of Contracture

Excessive proliferation of scar tissue following inflammation

Insufficient dissection area or pressure from the implant

Atrophy of skin, cartilage, and soft tissue

Excessive dissection or over-elevation during previous surgery

Visibility or displacement of the implant

Typical Changes That Appear as Contracture Worsens

The nose progressively lifts upward

The nasal tip becomes blunt and thick

The columella rolls backward and gets pulled upward

The nasal bridge becomes deviated and rigid

Accompanied by a shortened nose (Short Nose) + Upturned nose + Alar retraction

How can it be restored? An actual reconstructive approach

A contracted nose is not simply a "revision surgery," but a "reconstruction."

It must go through the following steps:

1. Removal of the contracted causative tissue

Complete dissection of the scar tissue (Scar capsule)

Key Causes of Contracture

The rigid scar tissue pulls the nose upward

Adhesions between the scar tissue and the implant are also removed

The process of "lengthening" the shortened tissue

Making micro-incisions in the shortened internal tissue to lengthen it (Release technique)

Lengthening and restoring the columella and medial crura

If this step is insufficient, contracture will recur even after revision surgery.

2. Nasal structural reconstruction (Foundation) work)

Erecting a support pillar using rib cartilage (donated or autologous)

Since the structural support of the columella and nasal tip has collapsed due to contracture,

downward supporting strength is secured with a sturdy pillar (Columellar strut + Extended spreader graft).

Finishing the nasal tip naturally with ear cartilage

Maintaining a rounded shape

Relieving stiffness

Securing natural luster and movement

Columella lengthening

"Pulling down" the columella from a position higher than the alae to restore it to its original position.

3. Nasal bridge reconstruction

Overlaying cartilage to induce derotation so that it "cannot ride upward"

This process is the key.

It serves to block it from being pulled upward again like the previous contracture.

Implants (silicone) can be reused

Many people ask this:

“If contracture has occurred, shouldn't silicone not be used?”

→ That is not necessarily the case.

Rather than silicone itself being the problem,

Incorrect positioning,

Insufficient dissection,

Inadequate care after inflammation occurs

are often the real causes.

If necessary, silicone, or

costal cartilage / donated dermis / dermofat is used on the nasal bridge.

There is no single correct answer; it is case by case.

After contracted nose surgery

Frontal changes

Removal of blunt scar tissue on the nasal bridge

Nose returns to the midline

Columella descends below the alae, restoring its normal position

Reduction of the bulging, blunt volume at the nasal tip

Profile changes

No longer upturned

The nasal tip is elongated, forming a natural angle (projection)

Disappearance of the upturned nose characteristic of contracture

As a result,

It is restored to a structure close to the "appearance of the normal nose you last saw."

Reflections by Facial Designer Dr. Kim Seong-hoon

“A contracted nose is not a matter of surgical technique, but of anatomical understanding and restoration philosophy."

Rather than forcefully erecting a collapsed structure,

only by releasing what has hardened, lengthening what has shortened,

and supplementing deficient areas with the precise materials

can a nose that will not collapse again be achieved.

I always say this:

'Just because contracture has occurred does not mean it's the end.

As long as the tissues allow, it can be fully restored.'

The more difficult the nose is, the more delicately and deeply we look into it,

the way will be found.

FAQ

Q1. Can a contracted nose return to its original shape?

Yes. It is fully possible if scar tissue removal + tissue lengthening + structural reconstruction are performed together.

Q2. Can silicone be used again even if the contracture is severe?

It is possible depending on the case. In many cases, the issue was the method of use rather than the silicone itself.

Q3. When can contracture revision surgery be performed?

The standard is after 6 months when the tissues soften, but the "condition of the tissues" is more important.

Q4. Is there any chance of contracture recurring?

If proper cartilage reconstruction and scar tissue removal are carried out, the possibility of recurrence is significantly reduced.

Q5. Can an upturned nose with a severely raised tip also be improved?

Yes. It can be sufficiently corrected through columella lengthening + cartilage strut reconstruction + skin stretching.

Q6. My nose is severely deviated, is reconstruction possible?

A significant portion can be corrected through midline adjustment, scar tissue removal, and cartilage repositioning.

SH Plastic Surgery Clinic