Methods for correcting a drooping and crooked nose

Hello, I am Dr. Peter C. Kang.

Today, I would like to discuss revision rhinoplasty using autologous rib cartilage for a patient whose nose began drooping and deviating due to the resorption of previously placed donor rib cartilage.

In this case, the patient had undergone nasal tip surgery using donor rib cartilage. Starting about 1 to 2 years ago, the shape of the nasal tip deformed, becoming drooped and deviated to the left, which the patient wished to correct. Because the patient had also undergone philtrum reduction after rhinoplasty, the nostril asymmetry had become more pronounced. Having had several prior rhinoplasties, including alar reduction, the internal nasal cartilage was severely damaged; donor rib cartilage had been used for everything from cartilage reconstruction to septal extension. It was judged that rapid structural changes occurred as the donor rib cartilage underwent partial resorption.

Therefore, we planned internal nasal cartilage reconstruction and septal extension using autologous rib cartilage.

Let us examine the preoperative photos and the day 0 immediate postoperative photos. Immediate postoperative photos show swelling and may differ from the final result.

Looking at the profile view, the compressed appearance of the nasal tip and the decreased nasolabial angle show significant improvement.

In the oblique view, you can confirm that the shape of the nasal tip has changed substantially.

From the front view, the noticeable crookedness caused by the nasal tip tilting significantly to the left has improved considerably.

Looking at the nostril view, although there were limits to correcting the nostril asymmetry due to alar asymmetry resulting from the prior alar reduction and philtrum reduction, you can see that it has improved considerably.

Both donor rib cartilage and autologous rib cartilage are excellent rhinoplasty materials. However, their advantages and disadvantages are clearly distinct.

Donor rib cartilage is very convenient to use because it is readily accessible. However, the circumstances in which it can be used are limited. In other words, it cannot be used in settings associated with inflammation, and the resorption rate varies widely depending on the patient's immune sensitivity. This means that the resorption rate can differ even when the same donor rib cartilage is used in different patients.

While donor rib cartilage is certainly a good rhinoplasty material, when compared directly with autologous rib cartilage, differences exist in resorption rates and durability. For this reason, when cartilage resorption and resulting deformity are strongly suspected in patients who previously underwent surgery with donor rib cartilage, I actively advise using autologous rib cartilage.

Today, we briefly discussed donor rib cartilage and autologous rib cartilage. I hope this provides helpful information for those contemplating the choice of rhinoplasty materials.

This was Dr. Peter C. Kang. Thank you.