Contracted Nose Rhinoplasty :Contracted nose also called retracted nose could be due to any nose injury, repeated nose surgery and rejection of grafts. Contracted nose correction should be planned after thorough nose history, reasons for failure of previous rhinoplasty and the type of augmentation materials used in previous nose job. In the past and even today some surgeons use silicone to increase the height of the nasal dorsum and lengthen the nose. In most of patients silicone is not accepted, this is because after few months or a year silicone wont be stable and moves its position and also nose tissues do not epithelize the silicone properly. Sometimes patients face a complication of implant exposure out of the nose or nose infection. All these contribute to contraction of the nose that requires secondary rhinoplasty surgery.
Open Rhinoplasty incision is preferred to correct the contracted nose. Secondary Rhinoplasty of the contracted nose is usually performed to correct the problem which was as a result of primary rhinoplasty surgery or augmentation materials used in the previous surgery. Contracted Nose correction should be plan properly only after 3 months. Composite grafting, spreader grafts, strut grafts and onlay grafts are used to correct the contracted nose. The lower lateral cartilages should be derotated, pulled forward and spreader grafts placed to correct the contracted cartilages. To correct the retracted columella, skin undermining is done till upperlid to mobilize the skin. In rare incidences flaps may be required.
These days gortex is the material of the choice due to its compatability, acceptance and small rejection rate. Some individual feel their columella region is contracted after their first rhinoplasty surgery. These can be due to multiple rhinoplasties. Correction of contracted or retracted columella is done by dorsal nasal augmentation and columella strutgrafts to get a the columella its initial shape and position.
Contracted nose can also be due to shrinkage in the lower lateral cartilages or lack of adequate stength in the cartilages. so always weak cartilages should be augmented in the primary rhinoplasty itself to avoid any contraction of nose.