A Nose with Repeated Tip Drooping — Why It Was Planned with Autologous Rib Revision: Silicone Exchange and Ear Cartilage Reinforcement
2024. 1. 26.
A case re-operated for tip drooping after silicone + septal cartilage surgery, yet left with pinching and cartilage show-through even after inflammation treatment — why autologous rib cartilage was chosen for its lower absorption, the judgment behind changing silicone from 6.5mm to 5mm, and reinforcing the pinched area with ear cartilage.
Key points
- After silicone + septal cartilage surgery and even a septal-cartilage revision for tip drooping, this case remained with alar pinching and cartilage show-through even after inflammation treatment.
- Autologous rib cartilage was chosen to match the request "I just want the tip to stop falling" — but the material alone cannot guarantee no re-drooping.
- In a single open surgery, the too-high silicone was exchanged from 6.5mm to 5mm and the pinched area was reinforced with harvested ear cartilage.
If the same worry remains even after one revision for tip drooping, what should be done differently in the next surgery?
An autologous rib revision rhinoplasty case introduced by Dr. Hyung-taek Kim of KOWON Plastic Surgery. This patient had a first surgery with silicone + septal cartilage at another clinic two years earlier, was dissatisfied with tip drooping, and had a revision with septal cartilage a year ago to improve it. Inflammation findings then required ongoing treatment, but the pinched look near the alae did not improve — and a concern remained that cartilage showed through inside the nose, especially on the left side where the inflammation had been.
01
What was the preoperative state?
Before surgery, the bridge was quite high while the tip was drooping. In particular, viewed from the side rather than the front or 45 degrees, the bridge was awkwardly high and the tip lowered.
In summary, there were three problems to solve.
| Problem | State |
|---|---|
| Tip drooping | Recurring even after septal cartilage revision — the patient's top request was "that it not fall anymore" |
| Bridge-tip imbalance | The existing silicone was too high — an awkward line with a high bridge and low tip in profile |
| Pinching / show-through | Alar pinching remained even after inflammation treatment, with left cartilage show-through |
02
Why was autologous rib cartilage chosen?
Because what the patient ranked most important was "I just want the tip to stop falling," this time surgery with autologous rib cartilage was decided.
Rib cartilage is a material that must be weighed together with harvest-site burden and absorption/deformation potential. In this case autologous rib cartilage was chosen based on the required amount of support and the prior surgical history, but it cannot be ranked as always better maintained than ear or septal cartilage, nor can the absence of re-drooping be guaranteed. Autologous rib cartilage surgery can be seen further in the autologous rib cartilage guide.
03
How was the surgery planned?
The surgery proceeded as an open approach, with the problem-by-problem plan as follows.
- Tip support — supporting the tip with autologous rib cartilage so it does not fall again
- Silicone exchange — the existing silicone was too high, so it was lowered and replaced to about 5mm from 6.5mm
- Pinch reinforcement — the pinched-looking area was reinforced with a small harvest of ear cartilage
The plan was not just to set the tip up — it lowered the bridge height that had been making the profile awkward and addressed the pinching left after inflammation, all in one surgery. What is judged together in revision is organized in the revision guide.
04
Summary — the more repeated the drooping, the more material and scope are viewed together
If tip drooping has repeated even after a revision, the support structure and the state of scar and soft tissue must be judged again — not just one material's name. This case planned autologous rib support, silicone exchange, and ear cartilage reinforcement of the pinched area together. The more repeated the problem, the more each material's limits and the whole structure must be explained comprehensively.
For a nose with multiple prior surgeries, a plan fitting the current state can be checked in a 1:1 video consultation.
Frequently asked questions
Answers to common questions patients ask before a consultation.
Can the tip droop again even after a septal cartilage revision?
What are the pros and cons of autologous rib cartilage?
In revision, is the existing silicone left as is?
Responses to treatment and recovery progress vary by individual. Outcomes and side effects vary from person to person. Bleeding, infection, swelling and asymmetry may occur. Please consult our medical team before making a decision.