The contracted nose is from the contracture of the soft tissue envelope of the nose.
When contracture of the soft tissue occurs, mobile and soft parts of the nose, which are around the tip of the nose, are pulled upward. The resultant nose is upturned, short, and immobile.
Then what makes the contracture of the soft tissue ?
Inflammation or infection of a nasal implant is the most frequent cause of a contracted nose.
Acute or chronic soft tissue inflammation around the nasal implant, usually by bacterial infection, induce the nasal soft tissue to shrink, and scar tissue build-up around the implant.
Fibrotic capsule around the implant tend to shrink over time.
Therefore, contraction of a degree can happen over a long period of time when a silicone implant is used.
However only an inflamed or infected implant makes the significant degree of contraction.
Even autologous cartilages or dermis can induce contracture, when they are infected.
Autologous materials are relatively strong against infection.
However, when they are infected, the result will be even more serious, because of the difficulty of removal.
The treatment of the contracted nose starts with infection control with antibiotics and irrigation treatments,
after removal of the infected implant or the graft.
It takes weeks to even months.
When infection is controlled, proper operation (reconstruction) timing must be decided.
When the infection is relatively mild, and controlled completely, immediate reconstruction with rib cartilages can be planned.
However, when the infection is relatively severe and resultant soft tissue damage is extensive,
the reconstruction must be delayed because of the chance of re-infection.
Usually the time of operation is delayed at least 6 months and 1 year preferably.
Below are the pictures of a patient with a contracted nose, who had delayed reconstruction with rib cartilages.