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Won et al. Plast Aesthet Res 2019;6:6 I http://dx.doi.org/10.20517/2347-9264.2018.82 Page 3 of 16

Figure 1. Infection of an alloplastic implant used for dorsal augmentation showing pus coming out from the nasal tip

Figure 2. Short and contracted nose after multiple rhinoplasties

Infection with alloplastic implants can occur immediately or years after surgery [Figure 1] [12-15] . Although
aggressive antibiotic therapy can be undertaken, the chances of implant salvage are low, especially in cases
where e-PTFE has been used [13,15] . There is no consensus on the timing of the definitive revision rhinoplasty
after implant removal. Currently, the mainstay of treatment is a staged approach with removal of the
alloplast and subsequent revision operation after infection control. Although it can provide a more sterile
environment, the delay in surgery can result in contracture of the overlying SSTE not to mention the added
[16]
frustration of the patient . In recent years, we have performed many reconstruction using autologous
cartilage, especially rib cartilage, after removal of an infected alloplast. We have found that the result is
[17]
favorable with minimal chances of infection and resorption .
Short, contracted nose
A short, contracted nose is a devastating complication usually associated with repeated surgery using
alloplastic grafting material [17-19] . The distorted anatomy lies not only in the structural support but also
in the overlying SSTE. The exact pathogenesis is yet unknown but possible etiologies include capsular
contraction around the implant, lower lateral cartilage necrosis by long term pressure from implants and
chronic inflammation that eventually leads to progressive scar contracture . As the contracture progresses,
[20]
the so-called snub nose deformity develops [Figure 2]. Therefore, caudal rotation of the tip together
with superior movement of the nasion to elongate the nose are necessary. Building a firm foundation
with autologous grafting material that can counteract the contractile forces of the skin is the key and rib