Rhinoplasty & Revision — It's Not About Materials, It's About Diagnosis
"Before we ask which material to use, we ask why this nose took the shape it has."
Procedure Overview
The outcome of a rhinoplasty is decided by the diagnosis, not by the name of the graft material. AVA Plastic Surgery classifies noses into five types (low bridge, dorsal hump, deviated nose, short nose, and revision/contracted) for diagnosis, and selects materials (ear cartilage, silicone, donated rib cartilage, autologous rib cartilage) based on the nose's history and goals. In particular, revision cases with contracture or deformity begin with extensive dissection of scar layers to release the contracture first.
Our nasal surgery decision framework shares the Stranc classification-based algorithmic approach from a paper co-authored by Dr. Kim Seungsoo (Park KS, Kim SS, Lee WS, et al. — Archives of Craniofacial Surgery, 2017, 18(2):97-104), and cartilage utilization and surgical documentation follow Gunter JP's Dallas Rhinoplasty standards.
Material Selection Criteria — "Always Rib Cartilage" Is Not the Right Answer
This is the misconception we correct most often. Autologous rib cartilage is not automatically the better choice; the nose's history and goals determine the material. AVA Plastic Surgery's selection criteria are as follows.
| Material | Selected When | Notes |
|---|---|---|
| Ear Cartilage (Conchal) | For tip refinement cases, when goals for tip height are moderate | Little donor-site burden; sufficient for many tip procedures |
| Silicone (Dorsum) | Common in Asians with inherently low nasal bridges | A practical option for creating dorsal height in low Asian bridges |
| Irradiated (Cadaveric) Rib Cartilage | When tip height is central to achieving results | Strong tip support with no donor-site morbidity |
| Autologous Rib Cartilage | ① Multiple revisions with depleted ear cartilage ② History of infection or foreign body reaction to allograft cartilage ③ Desire for both safety and strong projection | Autologous tissue eliminates the risk of immune rejection |
| Autologous Dermis | Generally avoided | Variable resorption can make final dorsal height difficult to predict |
When ambitions for tip height are modest, ear cartilage alone can produce a genuinely good shape. The principle is simple: choose what the nose needs, not the material with the most impressive name.
Five Nose Types — Type Determines Surgical Method
※ The following are Dr. Kim Seungsoo's actual diagnostic classifications. Final surgical plans are determined during consultation based on internal structural and skin condition assessments.
| Type | Core Principle | Approach |
|---|---|---|
| 1. Low Bridge | Design not only height but also 'thickness' | If the bridge is simply low, silicone and rib cartilage are sufficient. But a low bridge often comes with a bulbous tip — in those cases, dual-plane dissection thins the heavy soft tissue so the nose is refined as well as raised. |
| 2. Dorsal Hump | Severity determines method | Mild humps are rasped and smoothed with thin silicone overlay. Moderate to severe cases or specific dorsal conditions may require definitive correction — resecting the bony hump and performing osteotomies to realign the nasal bones. |
| 3. Deviated Nose | Find the 'layer' of deviation | Some noses improve with septal correction alone; when bone itself is deviated, osteotomy realigns bone first, followed by septal correction and shaping. |
| 4. Short/Upturned Nose | Extension without tension | Key is to adequately release the tip (lower lateral) cartilages from their ligamentous attachments, extend length, and dissect skin sufficiently for tension-free correction. |
| 5. Revision·Contracted Nose | The most challenging surgery — dissection is half the battle | The first step is separating the scarred soft tissue in the correct plane. Scar tissue is sometimes excised, sometimes unfolded and repurposed to restore volume. This is the territory where the surgeon's experience shows. |
Revision Surgery — 'Why Revise?' Determines Design
The first thing confirmed in revision consultation is the reason for revision. If the nose is contracted — hardened and drawn upward by a severe inflammatory response — the first step must be wide dual-plane dissection above and below the scar layer to release the contracture. By contrast, a simpler correction — exchanging an overly tall silicone implant for a lower one to relieve tension, say — may need only single-plane dissection, as in a primary surgery, though scar tissue still makes the dissection more demanding than a first operation.
Sequence for Contracted Revision
- Release Contracture — Dissect hardened areas at accurate layers to achieve comprehensive contracture release.
- Correct Asymmetry — Address bone/cartilage asymmetry.
- Tip Surgery — Shape tip height and contour.
- Implant Insertion & Fixation — Place appropriate implant over completed structure and secure.
Timing for Revision — Immediate vs Waiting
| Situation | Timing |
|---|---|
| Early correction within 2 weeks post-surgery | Immediate revision possible |
| Clear signs of infection | Immediate surgery (priority on removing causative material) |
| Ongoing inflammatory response → contracture | The causative material is removed right away. If the internal tissues are in good condition, reconstruction can be done in the same operation; when inflammation or contamination is severe, however, removal followed by a stabilization period of 6-8 months or more — until the nose has fully softened — makes the result more predictable and allows a better final shape. |
Not sure whether this applies to your case?
Send your photos and questions on WhatsApp Request a 1:1 consultationOpen Approach Principle — The Nose Must Be Viewed From Below
AVA Plastic Surgery uses open approach as standard for rhinoplasty. The completeness of a nose is determined not only by frontal and profile views but also by base view (proportions seen from below), and in our judgment a closed approach, with no external incision, can fall short of fundamental structural correction here — a shortfall that can surface later as implant deviation or imbalanced base proportions. The columellar incision typically fades over time (varies by individual).
When We Advise Against Surgery — and Honest Disclosure of Limits
The one case where AVA says "let's wait" is re-correction within 6 months of the previous surgery (the exceptions in the table above aside). Operating on tissue that has not yet settled makes the outcome hard to predict. Most other noses have room for improvement. When anatomy suggests the goal may not be fully reachable, we say so before surgery. Telling you clearly what is achievable and what will be difficult is, we believe, what earns trust in the result.
Why Autologous Rib Cartilage
- Reduced Risk of Rejection — As patient's own tissue, immunological rejection risk is lower
- Long-term Stability — Aims to reduce risk of deformation/exposure over time compared to implants
- Sufficient Volume — Even when septal cartilage alone is inadequate, reconstruction-level volume is obtainable
- Precise Carving — Customized carving for tip, dorsum, columella, spreader grafts, etc.
Harvest Site & Process
Cartilage is harvested from the right 6th-7th rib through an incision of roughly 3cm, placed along the bra line or an existing scar so it stays as inconspicuous as possible. The harvested cartilage is then refined and carved into the grafts the nose requires — dorsum, tip, columella, spreader grafts. Donor-site discomfort peaks in the first 1-2 weeks after surgery and gradually subsides (varies by individual).
Procedure Details
Recovery Course (Varies by Individual)
- Nasal Packing (Good to Know in Advance): After extensive dissection, the nose is packed internally for 2-5 days. Breathing through the nose is difficult during this time and the mouth gets dry — of everything we explain before surgery, this is the detail that surprises patients most. Knowing it is coming makes it far easier.
- 0-7 Days: External splint & internal packing. Peak swelling & bruising period.
- 7-14 Days: Splint removal, suture removal. Return to daily activities possible.
- 1-2 Months: 60-70% swelling stabilization.
- 3-6 Months: 80-90% swelling stabilization, nasal contour settling.
- 6-12 Months: Tip numbness recovery, final shape stabilization.
- Harvest Site: 1-2 weeks pain, gradually subsiding. Scar stabilizes in 6-12 months.
Possible Side Effects & Complications
- Temporary/persistent swelling, bruising, pain
- Left-right asymmetry, dorsal deviation — may change over time
- Tip numbness 6-12 months (most recover)
- Rib cartilage warping — refinement and fixation techniques aim to reduce risk but not 0%
- Harvest site pain, scar, pneumothorax (rare)
- Infection, bleeding, hematoma — rare but may require emergency treatment
- Tip visibility/protrusion — lower risk than implant rhinoplasty but not 0%
Nasal Fracture Treatment Experience & Rhinoplasty — How Papers Inform Surgery
Nasal bone fracture treatment and cosmetic rhinoplasty share more techniques than one might think. Just as mild fractures improve with instrument-based closed reduction, cases with severe or fixed deformity require osteotomy — the same technique used in correcting deviated noses and dorsal humps. Experience in realigning fractured noses forms the foundation for cosmetic surgery that realigns deviated and deformed noses through osteotomy. Surgical planning and documentation follow the international standard Gunter Dallas diagramming system.
- Park KS, Kim SS, Lee WS, et al. "The Algorithm-Oriented Management of Nasal Bone Fracture according to Stranc's Classification System." Archives of Craniofacial Surgery 18(2):97-104, 2017.06.
- Gunter JP. Dallas Rhinoplasty: Nasal Surgery by the Masters. (Autologous cartilage utilization & surgical documentation diagram standard)
Single-Surgeon System
Consultation, design, surgery, and aftercare are all handled by Dr. Kim Seungsoo. The next patient's schedule does not begin before the current patient's surgery is completed, and delegated (ghost) surgery does not occur.
Frequently Asked Questions (FAQ)
Q. Is rib cartilage always the best option?
No. When the desired tip height is modest, ear cartilage alone can produce a very good result. We turn to rib cartilage when ① multiple revisions have used up the ear cartilage, ② there has been infection or a foreign-body reaction to donated cartilage, or ③ you want both safety and strong, stable projection. The nose's history and your goals determine the material.
Q. When can I undergo revision surgery?
An early touch-up within 2 weeks of surgery, or a clear sign of infection, can be operated on right away. When inflammation or contamination is severe, however, it is wiser to remove the causative material first and wait 6-8 months or more for the nose to soften before revising — the result becomes more predictable. For a routine aesthetic revision, we recommend waiting 6 months for the tissues to stabilize.
Q. Will open rhinoplasty leave scars?
The columellar incision typically fades over time (varies by individual). The open approach allows for comprehensive structural correction including base view proportions, which is why AVA uses it as the standard.
Q. Why is nasal packing used after surgery?
After extensive dissection, internal nasal packing is used for 2-5 days to stabilize structures. During this period, nasal breathing is difficult and mouth dryness may occur. Being prepared for this beforehand makes the experience much easier.
Q. I'm nervous about the rib cartilage harvest.
The cartilage is taken through an incision of roughly 3cm, placed along the bra line or an existing scar. Discomfort peaks in the first 1-2 weeks after surgery and then gradually subsides (varies by individual).
Q. Can the implant be removed and only autologous cartilage used?
Yes. During consultation, nasal structure evaluation determines whether autologous cartilage alone or combined with partial implant is best.
Q. Can I use autologous cartilage for revision surgery?
Even if septal or ear cartilage is depleted from previous surgeries, rib cartilage can provide sufficient volume in most cases.
Q. How long is recovery?
External splint removal 7-14 days, return to daily activities 2-3 weeks, final shape stabilization 6-12 months (varies by individual).
Q. What is the cost?
Cost depends on how many prior surgeries are involved, the scope of correction, and how much cartilage must be harvested. A detailed quote is provided in a 1:1 consultation. Pricing is transparent and fixed — the same for every patient.
Coming from Abroad — Planning Your Trip
Patients who travel to Seoul for surgery usually want one question answered first: how long do I need to stay?
- Stay through suture removal. For surgical procedures sutures generally come out 7–10 days after the operation (see the recovery timeline above). Plan to remain in Seoul until your sutures are out and your surgeon has cleared you to travel. Exact timing is decided case by case.
- Consult before you book flights. Send photos and your questions through WhatsApp first. It is better to learn that a procedure is not right for you before a ticket is bought than after you land.
- Language and administrative support. We work with Yeon & Yeon, a medical-tourism partner agency staffed by attorneys admitted in both Korea and California, providing interpretation for English, Chinese, Japanese, Thai and Russian-speaking patients.
- After you return home. Recovery continues long after the flight back. Follow-up questions can be raised through the same WhatsApp channel you used before surgery.
Patient Photo Reviews
See real cases — photo reviews from our patients (written in Korean).
Appointments & Consultation
Clinic Hours: Weekdays 10:00-19:00 / Sat 10:00-17:00 / Closed Sundays & Holidays · Phone +82-2-545-1882
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※ Results and recovery may vary by individual; precise guidance is provided during consultation.
AVA Plastic Surgery Clinic · Business Registration 683-01-03871 · Gangnam-daero 603, Insung Bldg 4F, Seocho-gu, Seoul · ava-ps.com
Non-covered procedure costs can be found in the Non-Covered Cost Guide (VAT inclusion noted).