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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 13 of 16

A B C

D E F

G H I

Figure 18. Correction of the short nose due to contracture after multiple rhinoplasties. A short and contracted nose, developed after
infected dorsal silicone implant removal is evident from the preop photos (A, B, C); The surgical diagram shows septal extension graft,
dorsal onlay graft, bilateral extended spreader grafts, lateral crural onlay grafts, shield graft and cap graft were placed using irradiated
homologous costal cartilage (D); After wide release of the skin envelope, a septal extension graft is placed and reinforced with extended
spreader grafts. The released lower lateral cartilages and reinforced with extended lateral crural strut grafts. Perichondrium is added for
camouflage (E, F). One year after revision surgery using rib cartilage, the nose looks much better than before. His dorsum is well elevated
and the tip is caudally rotated (G, H, I)

the vestibular mucosa, a long, straight piece of cartilage fashioned from the rib cartilage was sutured to the
undersurface of the lateral crus with their cephalic ends extending to the pyriform aperture so that they
held the skin tension applied on the tip and lateral crus. In this way, lateral crural strut grafts strengthen
the lateral compartment and help to stabilize the dome in a more favorable position. Because the vestibular
skin is dissected off the lateral crus, it helps to reposition the vestibular mucosa more caudally.

Finally, the dorsum was elevated using a dorsal graft carved from the rib. A strip of perichondrium over
the costal cartilage was used as a dorsal onlay graft making a smooth transition from bony dorsum to
cartilaginous dorsum. The dorsal onlay graft was extended to include the nasion to elongate the nose.