Contracted Nose Revision Case — Correcting an Upturned, Shortened Nose with Autologous Rib Cartilage
2025. 10. 15.
An autologous rib cartilage revision case of a man who developed contracture — the nose pulling and appearing upturned about a year after rhinoplasty. The background of contracture, the material choices of donor vs. autologous rib cartilage, harvest under sedation with an ~2cm scar, and the revision sequence for a nose that had inflammation.
Key points
- If the nose pulls and looks upturned over time after rhinoplasty, contracture can be suspected. Contracture can develop according to individual tissue response to the silicone implant — it doesn't appear identically in everyone.
- For a nose with a contracture/inflammation history, materials are chosen after checking remaining tissue and infection status — autologous and donor rib cartilage are options with different sources. Donor rib cartilage is not autologous tissue.
- Anesthesia method and scar length for autologous rib harvest vary with harvest range and incision site — the ~2cm figure from this case can't be applied uniformly.
If about a year after rhinoplasty the nose starts pulling and looking upturned, it may be hard to dismiss as simple swelling or a temporary change. If the nose shortens and the nostrils tilt upward like an upturned nose, contracture symptoms should be checked.
Based on the contracted nose revision case of a male patient who actually came in with that condition, this article organizes why contracture develops and with which materials and sequence revision is approached.
01
Why does contracture develop?
Contracture is a symptom that can appear as a side effect of rhinoplasty. Especially when a silicone implant is used, it can develop according to each individual's tissue response. The important point is that it doesn't appear identically in every patient — since some develop it and some don't even with the same material, contracted nose revision must be approached carefully based on accurate cause analysis.
Even from the operating side, there are principles kept for prevention. To minimize tissue rejection, avoiding excessive implant insertion is important. Forcing the nose higher or overusing artificial material can produce an internal rejection response and lead to a situation requiring contracted nose revision.
In this case too, contracture symptoms — the nose pulling and looking upturned — appeared about a year after surgery. Because the nose had shortened and the nostrils tilted upward like an upturned nose, we decided to proceed with revision only after thorough consultation, imaging, and close examination of tissue state.
02
How is the revision material chosen?
In this case we considered rib cartilage materials in a direction that avoids reusing silicone. Note, though, that donor rib cartilage is an allograft processed from another person's tissue while only autologous rib cartilage is the patient's own tissue — the two must not be lumped into the same category.
| Method | Material |
|---|---|
| Donor rib cartilage | Uses specially processed cartilage from another person's rib |
| Autologous rib cartilage | Uses cartilage harvested directly from the patient's own rib |
This patient proceeded with autologous rib cartilage rhinoplasty. Many assume rib cartilage harvest requires general anesthesia, but it can be done sufficiently under sedation. Harvest time isn't long, and only a small scar of about 2cm remains at the harvest site — barely noticeable in daily life. The harvested rib cartilage is microparticulated and fabricated into a shape matching the nasal structure; at our clinic this approach is called RIBFIT™. Details are in autologous rib cartilage RIBFIT™.
03
What was corrected in surgery?
Before surgery, this patient's nose was deviated to the right, accompanied by septal deviation and rhinitis symptoms. The tip was lifted so the nostrils showed, and the overall facial balance was far from natural.
The surgery performed the following.
- Correcting the deviated nasal line — straightened the line bent to the right.
- Releasing the hardened tip tissue — released tissue hardened by contracture so the nasal length could extend naturally.
- Tidying nostril asymmetry — the nostrils, asymmetric before surgery, were made symmetric.
As a result, the tip came down softly and the overall impression became natural. Viewed at a 45-degree angle, the previously lifted tip with visible nostrils was corrected to a stable position — the nasolabial angle became natural, and the lip line and overall facial balance settled more smoothly.
04
If the nose had inflammation, the order is different
Contracture can also develop when inflammation persists long and internal tissue hardens. If inflammation is ongoing — pus being found, for example — treatment comes before revision.
- If the bacteria type is identified, the inflammation is controlled first with the matching antibiotic therapy.
- If antibiotic therapy doesn't improve it, the silicone is removed and irrigation performed, and revision may then be done after a recovery period of at least about 6 months.
- For a nose that had inflammation, the principle is using autologous tissue (autologous rib cartilage, autologous dermis, etc.) instead of silicone.
Because contracted nose revision isn't a purely cosmetic purpose but must accompany functional recovery, proceeding after the inflammation has fully settled is safest. For more on revision criteria, see the revision guide.
05
Summary — cause analysis and sequence decide the result
If the nose pulls and looks upturned after rhinoplasty, suspecting contracture and checking the state is advisable. In contracted nose revision, what matters is keeping this order: don't force implants in, finish treating inflammation first if present, and choose among autologous tissues the material matching the current state.
If you're worried about your nose's condition, the direction fitting your current state can be checked in a 1:1 video consultation.
Frequently asked questions
Answers to common questions patients ask before a consultation.
Does contracture happen because silicone doesn't suit the body?
Does autologous rib cartilage harvest require general anesthesia?
When is the best time for contracted nose revision?
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.