Surgical approach for a collapsed nose caused by septal cartilage damage

Hello, I am Dr. Peter C. Kang.

The patient visited NOSELAB wanting to correct an upturned nose. The main concerns were as follows:

• Left-sided nasal obstruction

• Drooping tip

• Nose deviated to the right

• High starting point at the glabella and an appearance suggestive of a dorsal hump

• Visible nostril show from the front and asymmetry

• Retracted columella leading to an acute nasolabial angle and the appearance of a protruding mouth

The patient's requests were as follows:

• Overall nasal elevation

• Correction of upturned nose

• Correction of wide nose

• Lifting the alae if possible

An important point was that the patient had already undergone rhinoplasty twice before. This was a critical factor affecting the surgical plan.

Taking the prior surgical history into account, we established the following surgical plan:

• Reconstruction of the septal cartilage

• Lower lateral cartilage reconstruction

• Removal of contracture tissue along the nasal bridge

• Maximally expanding the nasal skin envelope

• Reconstruction of the lower lateral cartilages to improve nostril appearance

• Nostril sill reduction and alar base elevation

• Correction of the nasolabial angle

• Nasal height elevation

The surgery was complex and took about 2 hours longer than anticipated. The main surgical steps were as follows:

a) Dissection of the alar cartilages

• Both lower lateral cartilages had already been removed.

b) Assessment of the septal cartilage status

• Most of it had been removed, leaving only a small portion along the dorsum and columella.

• The tip support framework was severely weakened.

• Cartilage added to the left side of the septum during a previous surgery had narrowed the left nasal cavity, causing nasal obstruction.

c) Reconstructive surgery

• Using autologous rib cartilage, we reconstructed the entire septal cartilage and both lower lateral cartilages.

• Contracture tissue along the nasal bridge was excised, and the skin envelope was expanded as much as safely possible.

• To improve nostril shape and symmetry, the lower lateral cartilages were completely reconstructed using autologous rib cartilage.

d) Additional corrections

• We performed nostril sill reduction and alar base elevation.

• The nasolabial angle was corrected.

• We maximized the skin envelope expansion to improve overall nasal height.

a) Profile view

• The nasolabial angle has clearly been corrected.

• The nasal tip projection has increased significantly relative to the forehead bone.

• The drooping appearance of the tip has improved.

b) Oblique view

• The definition and projection of the nasal tip are noticeably restored.

c) Front view

• The previously deviated portion has significantly improved.

• The thinned tip appearance and excessive nostril show have been corrected.

• The elevated position of the alae can be confirmed.

d) Nostril view

• The tilted columella has been straightened.

• The narrowed left nasal passage has improved substantially.

• Nostril asymmetry improved significantly.

• The nostril sill width has been noticeably reduced.

In revision rhinoplasty patients, the internal anatomical findings frequently differ greatly from what was reported about previous procedures. At times, the actual structural damage is more severe than anticipated, and it is regrettable that this can be difficult to fully explain in advance.

In revision cases, where and how previous surgeries were performed is often more important than the simple number of operations. Even with the same number of prior surgeries, the internal anatomy and surgical outcomes can vary widely.

Whether structural reconstruction is required creates a substantial difference in operative time, outcomes, and prognosis. Because this alters the surgical plan, it is vital to share as much accurate detail as possible about your prior surgeries during the initial consultation.

Although this patient's surgery took 2 hours longer than expected, reconstructive surgery enabled us to achieve a favorable outcome.

I hope this case is informative for those troubled by septal cartilage damage or nasal deformities. Through a thorough consultation with a specialist, you can find the surgical approach best tailored to your individual needs. We will continue to work together toward healthy, well-balanced nasal results.

Frequently asked questions (FAQs)

1. How long is the recovery period after surgery?

Although recovery periods vary by individual, patients can generally return to daily activities in about 1-2 weeks.

2. Are cartilage grafts safe?

Yes, cartilage grafts are safe, and when autologous cartilage is used, the risk of rejection is minimal.

3. How is the pain after surgery?

There may be mild pain after surgery, but it can be managed with prescribed pain medication.

4. When can the surgical results be seen?

As swelling subsides, results gradually become visible after 1-2 months.

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