Contracted Nose and Infected Nose, a Complex Case Review

The surgeons at S45 Clinic often see complex cases, and this was another very challenging one, because the patient had already had rhinoplasty 4 times and had 2 repeated infections. Some surgeons may decline a case like this. At S45 Clinic, the surgeon assessed the case and planned a revision to help the patient regain her confidence.

Contracted Nose and Infected Nose

“I had rhinoplasty, and then 1 to 2 weeks after a revision my nose became infected, so the silicone implant had to be removed. I waited 1 month and had it done again, but the new rhinoplasty got infected again, and in the end the implant had to be removed once more. Now my nasal tip has shrunk back a lot and I have lost all my confidence. After I saw another patient’s review, I wanted to have it done by Dr. Ty (นายแพทย์กิตติศักดิ์ วงค์เทียนชัย, ว.35602) at S45 Clinic, so I booked a consultation straight away.” (Khun Da)

Dr. Ty’s Assessment of the Patient’s Nose

• The nose had repeated infections and long-term inflammation. When the silicone implant was removed, it left a clearly visible dent at the nasal tip.
• There was a lot of scar tissue, which contracted and pulled the nose upwards.
• Blood flow in the small blood vessels inside the nose was poor.
• The skin on the nose was in poor condition and had hardened, so the tissue did not stretch easily, which made the operation difficult.

What to Do If Your Nose Gets Infected After Rhinoplasty

Research reports that rhinoplasty with a silicone implant has a higher chance of infection than other materials, at about 5%. With any surgery, or even a cut from a knife, there is a chance of infection if the wound is not cared for properly. So if you have had an infection after silicone rhinoplasty, the advice is to remove the implant and let the nose rest first. After that, it is up to you whether to have rhinoplasty again.

If you do not want rhinoplasty again, fat grafting may be used instead. If you do want a new rhinoplasty, it can be done after the nose has rested and the infection and inflammation have been treated. In this case, the patient had waited 6 months after the implant was removed before coming for a consultation about a new rhinoplasty.

Hybrid Rib Rhinoplasty to Help Regain Confidence

In this case Dr. Ty operated for 4 hours, starting by gradually releasing all the scar tissue, because dense scar tissue ran from the inner corners of the eyes to the nasal tip and had pulled the nose into a contracted, upturned shape, as if a finger were pushing the nose up. Because the patient had had an infection with a silicone implant before, the surgeon also had to take care to prevent another infection and to allow for thin skin on the nose. Dr. Ty therefore recommended hybrid rib rhinoplasty, which opens the nose to correct the structure using rib cartilage.

Dr. Ty placed rib cartilage along the central structure of the nose to strengthen it, and used rib cartilage to lengthen the nasal tip so it projects forward. This helps lower the chance of implant extrusion and helps the nose suit the face more than using silicone alone.

When the patient saw her nose she was very happy. The shape looks more attractive than before and she has had no further infections. The patient trusted Dr. Ty at S45 Clinic, and the revision gave a result she was delighted with. Results depend on each person.

Note: Repeat nose surgery, which many people know as ‘revision rhinoplasty’, is surgery for people who have had nose surgery before and need a further assessment by a surgeon. The approach to care depends on the original problem, the nasal structure and the surgeon’s judgement in each case.