A Nose That Shortened After Surgery — Autologous Rib Revision Case: Why Contracture Happens and How Far It Was Corrected

2024. 4. 5.

Why the tip shortens after rhinoplasty (cartilage absorption, tissue contraction) and a revision case where the glabella, tip length, and nostril asymmetry were corrected with low-absorption autologous rib cartilage.

Key points

If the tip looks shorter after rhinoplasty, causes must be distinguished: cartilage change, tissue contraction, support structure, and scar state.
In this case the glabella, tip, and nostrils were corrected with autologous rib cartilage — but material alone can't guarantee against recurrence.
Nostril asymmetry correction and nostril lowering were done together, tidying the lifted-looking tip and the visible-nostril impression.

Some people look into revision because the first surgery was fine, but over time the tip shortened and started looking lifted. A short-looking tip can give a youthful impression — but when the tip is too short and the nostrils show, it can give a somewhat untidy feeling.

Through a case of a patient who came in with that state and received autologous rib revision, this article organizes why a nose shortens after surgery and the scope corrected in this case.

Why does the tip shorten after rhinoplasty?

In this case the nose had a short-looking tip that was so lifted the nostrils showed. Presumably right after the first surgery the nose wasn't this short — but tips shortening after rhinoplasty is common.

The causes can be divided broadly into two.

Cause	What happens
Cartilage absorption	As the cartilage supporting the tip absorbs, length and shape change
Tissue contraction (contracture)	Tip tissue hardens and contracts, shortening the nose — commonly called a 'contracted nose'

In this patient the alar area looked unnaturally pinched — and by that appearance, both factors seemed present. In such a state, rather than just re-setting tip position, material choice and correction scope must be judged together so the same thing doesn't repeat. What to check in revision is organized in the revision rhinoplasty guide.

How was it corrected in this case?

Autologous rib cartilage was used aiming to reduce recurrence risk, but individual planning is needed including the possibility of absorption/deformation and donor-site burden. What was corrected:

Lowered the glabella while extending the tip — rather than only raising, the glabella height was lowered while the shortened tip was extended, for a more natural line.
Nostril asymmetry correction — nostril asymmetry was present and corrected together.
Nostril lowering — performed together to correct the impression of the nostrils being peeked into.

After surgery, along with nasal length, a change was observed where the columella beneath the nose — which had looked too tight and lifted — came down with room to spare. At our clinic, the method of microparticulating autologous rib cartilage and fabricating it into a shape matching the nasal structure is called RIBFIT™. Details are in the autologous rib RIBFIT™ guide.

Summary — first distinguish why it shortened

If the nose shortened after surgery, what caused the shortening must be distinguished before "how much to lengthen it back." Material choice and correction scope differ depending on whether it's cartilage absorption or tissue contraction — and as in this case, accompanying problems like nostril asymmetry or nostril exposure must be tidied together for the overall impression to become natural.

Frequently asked questions

Answers to common questions patients ask before a consultation.

If the nose shortened after surgery, is it always contracture?

Not always. There are cases where cartilage absorbs and it shortens, and cases where tip tissue hardens and contracts (contracture). Clues can come from appearance — like the alae looking pinched as in this case — but both can be present together, so the state is checked directly before judging.

Why was autologous rib cartilage used in the revision?

In this case both cartilage change and tissue contraction were suspected, so autologous rib cartilage was used. But being autologous rib cartilage alone can't guarantee no absorption or recurrence.

Isn't extending just the tip enough?

In this case it wasn't tip extension alone. For a natural line, the glabella was lowered while the tip was extended — and nostril asymmetry correction plus nostril lowering to fix the looked-into-nostrils impression were done together. How far to correct is decided by looking at the whole nose's state.

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.

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