Upturned nose surgery is difficult for all skin types but is comparably easy to manipulate the functions. But contraction caused from extraneous substance hardens the skin making the surgery more difficult. If the nose continues to shorten after inserting silicone you should alternate it.
This patient had a crooked silicone and developement of construction due to silicone. There is no difference whether you put in cartilage or dermis in the nasal tip after inserting the silicone.