VIDEO

Operative Technique
Contracted Nose Correction with Dermofat and
Conchal Cartilage
Jae Hoon Kim, MD, PhD; Jin Woo Song, MD; Sung Wan Park, MD

I
n Asian rhinoplasty, for patients who mostly have low
and small noses compared to Caucasians, the most fre-
quently performed procedures are nasal tip projection,
lengthening and augmentation.
Various alloplastic materials such as silicone, polytet-
rafluoroethylene, high-density polyethylene (Medpor,
Stryker), etc., have been applied for such operations even
until recently.1,2 However, when these implants are used
improperly or cause infection, it may result in severe con-
tracture that is very hard to correct.

STEPS
1. Dermofat graft is harvested from sacral area.
2. T he soft-tissue skin envelope (STSE) is elevated su-
perficially from the scar tissue as evenly as possible.
3. All the alloplastic materials are removed.
4. The alar cartilage is made by complete release of
the scar tissue or the support structure that has been
holding the tip structure firmly.
5. Alar cartilage compound is fixed without tension to
proper location using extension or spreading grafts.
6. Dorsal augmentation with dermofat graft.
7. Tip plasty by shield graft and cap graft with conchal
cartilage and reinforcing nasal tip with a piece of
dermofat.
OPERATIVE TIPS
See Video 1, Supplemental Digital Content 1, which
demonstrates elevation of skin and soft-tissue envelope
(STSE) superficially from the scar tissue, and removal of
alloplastic materials. This video is available in the “Related
Videos” section of the Full-Text article on PRSGlobalO-
pen.com or available at http://links.lww.com/PRSGO/A412.
In this video case, which is secondary rhinoplasty, I cor-
rect the contracted nose with dermofat graft and conchal
cartilage graft as autologous material. The video demon-
strates STSE elevation and Medpor that was applied for
From the April 31 Plastic Surgery Clinic, Seoul, Korea.
Received for publication October 21, 2016; accepted January 27,
2017.
Copyright © 2017 The Authors. Published by Wolters Kluwer Health,
Inc. on behalf of The American Society of Plastic Surgeons. This is
an open-access article distributed under the terms of the Creative
Commons Attribution-Non Commercial-No Derivatives License 4.0
(CCBY-NC-ND), where it is permissible to download and share the
work provided it is properly cited. The work cannot be changed in
any way or used commercially without permission from the journal.
Plast Reconstr Surg Glob Open 2017;5:e1272; doi: 10.1097/
GOX.0000000000001272; Published online 25 April 2017.
Video Graphic 1. See video, Supplemental Digital Content 1, which
shows elevation of skin and soft-tissue envelope (STSE) superficially
from the scar tissue, and removal of alloplastic materials. This video is
available in the “Related Videos” section of the Full-Text article on PRS-
GlobalOpen.com or available at http://links.lww.com/PRSGO/A412.
septal extension, and spreading is removed. The second
video displays scar tissue, and alar cartilage compound
is sufficiently released from surrounding contracted scar
and upper lateral cartilage.3 (See Video 2, Supplemental
Digital Content 2, which shows the free movement of the
alar cartilage, without tension, after complete release of
the scar tissue or the support structure and the rebuilding
of the nasal tip with derotation type dorsal batten graft.
This video is available in the “Related Videos” section of
the Full-Text article on PRSGlobalOpen.com or available
at http://links.lww.com/PRSGO/A413.) When destruction
or deformity of alar cartilage is extreme with severe scar
formation, it should be released as the alar compound with
certain shape and volume rather than trying to separate
the scar from alar cartilage completely. Septal cartilage
is not harvested concerning instability of caudal septum
where Medpor was applied. Extended alar compound is
fixed by derotation type dorsal batten graft4 using conchal
cartilage.
The third video shows dermofat graft being harvest-
ed mostly from sacral region where the thickest dermis
can be obtained5 and is molded into a suitable shape by
molding sutures. By such molding technique that is in-
troduced by Dr. Jo, Korean plastic surgeon, not only the
most suitable shape can be achieved but also substantial
Disclosure: The authors have no financial interest to ­declare
in relation to the content of this article. The Article Processing
Charge was paid for by the authors.

www.PRSGlobalOpen.com 1

Video Graphic 2. See video, Supplemental Digital Content 2, which
shows the free movement of the alar cartilage, without tension, after
complete release of the scar tissue or the support structure and the
rebuilding of the nasal tip with derotation type dorsal batten graft.
This video is available in the “Related Videos” section of the Full-Text
article on PRSGlobalOpen.com or available at http://links.lww.com/
PRSGO/A413.
Video Graphic 3. See video, Supplemental Digital Content 3, which
shows harvest and manipulation of dermofat graft. This video is avail-
able in the “Related Videos” section of the Full-Text article on PRSGlo-
balOpen.com or available at http://links.lww.com/PRSGO/A414.
decrease of absorption rate is possible. (See Video 3,
Supplemental Digital Content 3, which shows harvest and
manipulation of dermofat graft. This video is available in
the “Related Videos” section of the Full-Text article on
PRSGlobalOpen.com or available at http://links.lww.com/
PRSGO/A414.)
Also, skin dimpling on nasal tip is corrected by un-
derlying supporting graft with a small piece of conchal
cartilage, and favorable nasal tip contour is made with der-
mofat graft. (See Video 4, Supplemental Digital Content
4, which shows nasal tip plasty using shield graft and cap
graft, correction of the skin dimpling on nasal tip. This
PRS Global Open • 2017
Video Graphic 4. See video, Supplemental Digital Content 4, which
shows nasal tip plasty using shield graft and cap graft, correction of
the skin dimpling on nasal tip. This video is available in the “Related
Videos” section of the Full-Text article on PRSGlobalOpen.com or
available at http://links.lww.com/PRSGO/A415.
video is available in the “Related Videos” section of the
Full-Text article on PRSGlobalOpen.com or available at
http://links.lww.com/PRSGO/A415.)
DRESSING
For prevention of hematoma, internal compressive
splint with silastic sheet and Merocel (Ivalon) sponge was
applied after surgery. For external dressing, gauze pillows
are applied with Joseph dressing to give gentle compression
on the sides, and peripheral venous catheter is inserted.
Jae Hoon Kim, MD, PhD
April 31 Plastic Surgery Clinic
6th floor, Geonwoo B/D, Gangnam-daero 548
Kangnam-gu, Seoul 135-010
Korea
E-mail: april31kjh@naver.com
PATIENT CONSENT
Patients provided written consent for the use of their images.
REFERENCES
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and implants in rhinoplasty: part II. Homologous grafts and al-
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ed with alloplastic implants in rhinoplasty. Arch Facial Plast Surg.
2012;14:437–441.
3. Kim JH, Song JW, Park SW, et al. Tip extension suture: a new tool
tailored for Asian rhinoplasty. Plast Reconstr Surg. 2014;134:907–916.
4. Paik MH, Chu LS. Correction of short nose deformity using a sep-
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Surg. 2014;41:12–18.
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