The most prevalent surgeries performed among Asian patients to change their characteristic short, flat noses and broad nasal tips are lengthening and augmentation procedures. Despite the number of various materials available for use in rhinoplasty, implants, particularly silicone, persists to be most widely used in Asia to this day.

On the contrary to its extensive use, non-autologous materials have been reported to cause an array of complications, of which many proceed to the development of a contracted nose. The contracted nose is manifested with a tight and hardened nasal envelope that induces multiple deformations to the shape of the nasal tip revealing an appearance of a severely shortened nose. It can lead to acute complications of severe nasal deformities and functional problems of obstructed nasal airway. The cause for contracted nose remains to be unclear; however, host immune reaction, an innate immune system’s response to foreign substances, is believed to be the primary reason in addition to the presence of persistent predisposing factors for infection development in rhinoplasty.

Nasal contraction may be classified according to the surgical method of treatment used: partial contraction, symmetric contraction, asymmetric contraction, general contraction, contraction accompanied by skin damage, and destructive contraction that requires nasal reconstruction. In the case of multiple revision patients who are often graft-depleted, it is best to use autologous materials such as rib cartilage in conjunction with the extension of mucosa, skin, and supporting cartilaginous structures. For the repair of severe deformities typically associated with contracted nose, flaps are often used utilized for nasal reconstruction. Commonly, local flaps such as alar rotation flap, sub-nasal flap, and buccal flap are used, but in acute cases, regional flaps such as melolabial flap or forehead flap can also be employed.

Since a contracted nose requires restoration of both the functional and aesthetic aspects, higher level of knowledge and experience is required on the physician’s part. In addition, patients tend to exhibit signs of mental illness as a result of the nasal defect, which calls for the need of a more technical approach than a psychological one in resolving the problem.

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