GuidesNose
Contracted nose correction: rebuilding a short, stiff nose after surgery
A contracted nose is a nose that has become short, firm and pulled up after earlier surgery, usually because scar tissue or a tight capsule around a silicone implant has shrunk. Correction is a revision rhinoplasty: the surgeon releases the scar, often removes the implant and rebuilds length with cartilage, commonly rib. Plan 7 to 10 days in Seoul.
What is a contracted nose?
Contracted nose is the name Korean clinics and surgeons use for a nose that has shrunk after rhinoplasty. In English research papers you will also see it called a contracted nose deformity or a short nose deformity after silicone implant surgery. It is a complication of earlier surgery, not a nose that was short from birth.
Urban Plastic Surgery, our partner clinic, lists a nose whose shape has changed after tissue damage or inflammation among the reasons for its revision rhinoplasty. A nose that has always been short or upturned, with no earlier surgery, is a different problem with simpler options, covered on our short nose correction page.
The change usually comes on over months, not overnight. People most often notice some of these signs:
- The tip has moved up, so more of the nostrils shows from the front.
- The nose looks shorter from the side than it did after the first surgery.
- The tip feels hard and barely moves when you press it.
- The skin over the tip or bridge looks tight, shiny or red.
- An implant outline has started to show, or the bridge has shifted to one side.
Why does a nose contract after surgery?
Around a silicone nose implant, the body forms a thin capsule of scar tissue. Usually it stays soft. In some people it thickens and tightens over time (capsular contracture). Because the skin of the nose is attached to that capsule, a tightening capsule pulls the tip up and back and shortens the nose. A review of rib cartilage in Asian rhinoplasty describes how complications from silicone implants can make the soft tissue contract and damage an already fragile nasal structure.
Infection and long-lasting inflammation are a second cause. A case report of two patients with repeated infections around silicone bridge implants describes chronic inflammation of the tip and the columella (the strip of skin between the nostrils). It notes that the scarring left behind makes the usual ways of lengthening a short nose harder to use.
Repeated surgery adds to both. Each operation leaves more scar tissue, and a first rhinoplasty often uses up much of the septal cartilage that would otherwise support the tip. The skin itself can become thinner and less stretchy. That is why a contracted nose is usually a problem of the skin and lining as much as of the framework underneath.
How common is it? A Korean study of 695 people after silicone augmentation rhinoplasty sorted the results into 4 grades. A short nose deformity, the most severe grade, was seen in 3.0%. Revision surgery was recommended for the 13.8% whose results fell in the 2 most severe grades: an implant clearly off center, or a short nose. Rates vary between clinics and studies, so treat these figures as a rough guide.
How is a contracted nose corrected?
Correction is a revision rhinoplasty, usually through an open approach, and most plans combine several steps. To plan it, our partner clinic takes a 3D CT scan. In a revision, the scan helps the surgeon judge the size and position of an old implant and spot a bent or damaged tip cartilage before the operation starts.
- Remove what is causing the pull. An old silicone implant usually comes out, along with the tight capsule where the surgeon judges it necessary.
- Release the scar. The skin and lining are freed from the scar tissue underneath, so they can stretch over a longer framework.
- Rebuild support. Strong cartilage grafts extend the septum and support the columella and tip, so the nose can be brought down and lengthened. A new bridge is built with cartilage or, in some plans, a new implant.
- Close without tension. The surgeon lengthens only as far as the skin can cover safely, because skin stretched too tight heals poorly.
Why is rib cartilage used so often?
A contracted nose needs a lot of firm cartilage, and after earlier surgery there is often little septal cartilage left. Ear cartilage is soft and curved, which suits small tip changes but not the strong support needed to hold a nose in a longer position against scar. A rib can supply enough firm cartilage for all three jobs at once: extending the septum, propping up the columella and building a new bridge.
Our partner clinic’s English site names rib cartilage as an option for columella support in short or retracted noses, and says it is commonly taken from the 6th to 10th ribs through an incision on the chest, which can leave a visible scar. Our page on rhinoplasty with your own cartilage explains the 3 donor sites and how recovery differs.
Donor rib cartilage, from a tissue bank, is treated with radiation before use and needs no chest incision, but our partner clinic notes a slightly higher risk of infection than with your own rib. Whether your own rib or donor rib suits your nose is a decision for the surgeon. Our guide to rhinoplasty materials compares the two side by side.
How long should you wait before a correction?
Most surgeons wait about a year after the last nose surgery, so that swelling settles and scar tissue softens before they operate again. Scar that is still active is harder to release and more likely to tighten again. Use the time to take photos every few weeks in the same light, and to collect your records.
Some problems should not wait. If an implant is infected, or is pushing through the skin, see a surgeon promptly, wherever you are. When an infected implant comes out, surgeons differ on timing. Some rebuild with cartilage in the same operation, as in the 2-patient case report above. Others let the infection clear first and rebuild later, accepting that the skin may contract more in the meantime. Your surgeon decides after examining you.
If you are not sure whether your nose is still changing, you can have a consultation well before any surgery. Our guide to planning revision surgery lists the operation notes, implant details and photos to bring.
What are the risks of contracted nose correction?
A contracted nose is one of the harder problems in revision rhinoplasty. The aim is a longer, softer, more natural nose, but a nose that has been operated on several times rarely looks as if it had never had surgery, and some people need more than one operation. The American Society of Plastic Surgeons notes that scar tissue can come back even after a successful revision.
For rib grafts, the clearest numbers come from a pooled analysis of 10 studies (491 patients) of rhinoplasty with the patient’s own rib cartilage. The grafts warped in 3.08% of cases, resorbed in 0.22% and became infected in 0.56%, and 5.45% of people developed a raised, thick (hypertrophic) chest scar. Results differed widely from study to study, and the figures cover rib rhinoplasty in general, not contracted noses alone.
- Scar tissue that tightens again and pulls the nose short, partly undoing the length gained
- Slow healing, or skin that breaks down over the tip, because earlier surgery has reduced the blood supply to the nose skin
- Infection, with a higher chance where an earlier implant was infected
- A rib graft that bends (warps) over the months after surgery and tilts the new bridge, which may need another correction
- At the chest: pain, a scar and, rarely, air leaking around the lung
- Swelling and stiffness that can take a year or longer to settle
- Breathing difficulty or asymmetry, sometimes needing further surgery
How long should you stay in Seoul?
For revision rhinoplasty, our partner clinic lists about 2 hours of surgery, sedation or general anesthesia, no overnight stay, stitches out on day 7, 2 to 3 follow-up visits and about 1 week before you are back to daily life. A contracted nose often needs rib cartilage and more rebuilding, so ask whether your own plan takes longer and whether a night at the clinic would be wiser.
Most people plan 7 to 10 days in Seoul. With a rib graft, book the full 10 days and confirm with the clinic which day your stitches are due, since the timing can shift. Your chest may still ache on the plane, so a later flight home is the more comfortable choice.
As after any operation, if you become breathless or have chest pain, get emergency care first, then tell the clinic. If rib cartilage is used, soreness at the chest wound that eases day by day is expected, but chest pain or swelling at the chest wound that comes on suddenly or gets worse needs emergency care first, then a call to the clinic. A nosebleed that does not stop is an emergency too: get emergency care first, then tell the clinic. If one side swells quickly and becomes more painful, especially soon after surgery, contact the clinic straight away; if you cannot reach the clinic, get emergency care. If a treated area blisters, or you see spreading redness, heat or fever, contact the clinic straight away. Whatever the emergency, wait until a doctor has cleared you before you board a flight.
What should you ask before you book?
We do not publish prices yet, because the cost of correcting a contracted nose depends on the repair plan. Implant removal, how much cartilage is needed and where it comes from, whether bone is cut and how many surgeries you have had all change the quote. Our surgery quote checklist shows what a written quote should list.
To ask about your own nose before you book flights, start a free consultation. A patient coordinator answers first, then the surgeon at the partner clinic that fits your case reviews your photos and consults in depth. Decisions about grafts and timing stay with the surgeon, because the coordinator is not a doctor. Our consultation is free for you, and you pay only the clinic’s own price for treatment.
These are the questions worth putting to the surgeon:
- What is pulling my nose short: the implant capsule, scar from infection, or missing cartilage?
- Will my implant come out, and will the capsule be removed as well?
- Which cartilage will you use, my own rib or donor rib, and why?
- How much length can my skin safely allow?
- Should I wait longer, or is my nose ready now?
- How many contracted noses do you correct, and who operates?
More questions
Can a contracted nose be fixed without rib cartilage?
Sometimes. A mild case with enough septal cartilage left may be rebuilt without rib. Most contracted noses need a lot of strong cartilage to hold the tip in a longer position against scar, so rib cartilage, your own or from a donor, is common. The surgeon decides after an exam and, at our partner clinic, a CT scan.
Will my nose be as long as it was before the first surgery?
Not always. How far the nose can be lengthened depends on how much the skin and lining can stretch after scarring. Pushing further than the skin allows risks poor healing. Ask the surgeon to show you a realistic target on your own photos.
Can a nose contract again after it has been corrected?
Yes, it can. Scar tissue can re-form after a revision and pull the nose short again, which is one reason surgeons favor strong cartilage support and careful timing. Follow your aftercare, keep pressure off the nose and report any change in shape early.
Does removing the implant alone fix a contracted nose?
Usually not. Taking the implant out removes the cause of the pull, but the skin and lining stay short and the bridge drops. Most plans rebuild length and support with cartilage in the same operation or, after an infection, at a later one.
Procedures in this article
Read next
Sources
- Contracted Nose after Silicone Implantation: A New Classification System and Treatment Algorithm. PubMed Central, US National Library of Medicine
- Asian Rhinoplasty with Rib Cartilage. PubMed Central, US National Library of Medicine
- Correction of severe columella and tip retraction in silicone implanted Asian short noses. PubMed Central, US National Library of Medicine
- Complications associated with autologous rib cartilage use in rhinoplasty: a meta-analysis. PubMed, US National Library of Medicine
- Understanding revision rhinoplasty and why patients seek out this procedure. American Society of Plastic Surgeons