How to reconstruct a nose upturned from contracture using autologous rib cartilage

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a rhinoplasty case of a patient who was troubled by a contracted and upturned nose.

In cases like this, the patient had been struggling with contracture and an upturned nose caused by inflammation following multiple nasal surgeries.

Although it was a complex revision rhinoplasty case, customized rhinoplasty using autologous rib cartilage brought about a significant transformation.

1. Patient history and requests

The patient's nasal surgery history:

- 2012: L-shaped silicone implant placement

- 2019: Silicone implant + autologous rib cartilage + alar reduction + philtrum reduction

- 2023: Silicone implant + ear cartilage + lowering the nostril rim (inflammation developed immediately after splint removal; treated with antibiotics)

- 2023 (5 months later): Silicone implant removal

- After visiting NOSELAB: 6 sessions of stem cell therapy performed

1. Correction of upturned nose

2. Correction of nostril asymmetry

3. Correction of the depressed nasal tip area

4. Creating a dorsal hump

5. Nasolabial angle correction

2. Preoperative design consultation

Let us analyze the patient's preoperative condition in detail:

Front view:

- Excessive nostril show and asymmetry are present

- The nasal bridge appears widened and flat

- A depressed scar is visible at the nasal tip

Oblique view:

- The nasal tip appears bulbous and upturned

- The nasal bridge is flat and lacks three-dimensional definition

Profile view:

- The nasal tip appears bulbous and compressed

- Excessive nostril show

- The nasolabial angle appears inappropriate

Nostrils:

- The nostrils are narrowed

- The columella appears wide

- The nasal tip is bulbous

- Nostril asymmetry is evident

3. Surgical plan

Taking into account the patient's condition and requests, the following surgical plan was established:

a) Septal extension using autologous rib cartilage

b) Septal reconstruction

c) Improving nostril asymmetry by shifting the septum to the left

d) Creating a dorsal hump using autologous rib cartilage

e) Lower lateral cartilage reconstruction using autologous rib cartilage

f) Correction of the nasolabial angle

4. Procedure details

The following procedures were performed using a closed approach:

a) Autologous rib cartilage harvest:

- The patient's rib cartilage was harvested to secure an adequate amount of cartilage for nasal reconstruction.

b) Septal extension and reconstruction:

- The septum was extended and reconstructed using autologous rib cartilage.

- Through this, the upturned nose was corrected and structural stability of the nose was secured.

c) Correction of nostril asymmetry:

- The nostril asymmetry was improved by shifting the septum to the left.

d) Creating a dorsal hump:

- A natural dorsal hump was shaped by delicately carving the autologous rib cartilage.

e) Lower lateral cartilage reconstruction:

- The lower lateral cartilages were reconstructed using autologous rib cartilage.

- Through this, the tip shape and support were improved.

f) Correction of the nasolabial angle:

- An appropriate nasolabial angle was created by adjusting the position of the nasal tip and septum.

All procedures were performed using a closed approach, completing the surgery without external scars.

5. Comparison of before-and-after photos

Comparing photos taken immediately after surgery on day 0 shows the following improvements: Photos taken immediately after surgery show swelling and may differ from the final result.

Front view:

- The upturned nose was corrected, significantly reducing nostril show.

- The nasal bridge appears more gathered and gained three-dimensional definition.

- Nostril asymmetry improved.

Oblique view:

- A natural dorsal hump line was formed along the bridge.

- The bulbousness and upturn of the nasal tip were improved.

- Nostril show was reduced, presenting a more natural appearance.

Profile view:

- The bulbous, compressed appearance of the nasal tip was corrected.

- A natural dorsal hump curve was created along the bridge.

- The nasolabial angle was corrected, improving the appearance of a protruding mouth.

- Nostril show was reduced.

Nostrils:

- The previously narrowed nostrils were appropriately widened.

- The wide columella was naturally narrowed.

- The bulbous nasal tip has been naturally improved.

- Nostril asymmetry improved significantly.

6. Photos taken immediately after surgery (day 0)Immediate postoperative photos show swelling and may differ from the final result.

7. Overall assessment

This was a complex revision rhinoplasty case where contracture issues resulting from multiple prior surgeries and inflammation had to be addressed. However, through customized rhinoplasty using autologous rib cartilage and meticulous surgical planning, a remarkable improvement was achieved.

Key points to note include:

1. Use of autologous rib cartilage: By utilizing an ample amount of autologous tissue, a stable and natural result could be obtained.

2. Septal reconstruction and extension: Played a pivotal role in resolving the upturned nose and structural instability.

3. Delicate dorsal hump formation: A natural dorsal hump line was created reflecting the patient's preferences.

4. Correction of nostril asymmetry: By adjusting the position of the septum, longstanding nostril asymmetry was improved.

5. Correction of the nasolabial angle: Harmony between the nose and lips was improved, enhancing overall facial balance.

Through this surgery, all of the patient's requests were successfully met. The upturned nose was corrected, nostril asymmetry was improved, and the depressed area of the nasal tip was naturally corrected. In addition, the requested dorsal hump was shaped and the nasolabial angle was corrected to create a harmonious nasal contour.

8. Concluding remarks

I hope this case brings hope to those suffering from contracted and upturned noses. In reconstructive surgery for contracture caused by inflammation, the actual surgical findings often differ significantly from pre-operative expectations, making it very difficult to predict outcomes accurately. Therefore, at NOSELAB, for such complex revision rhinoplasty cases, we strive to achieve a positive impact on surgical outcomes by combining pre-operative stem cell therapy.

I would also like to emphasize once again the importance of surgery using autologous tissue. Particularly in complex revision cases, using autologous tissue supports a more stable and natural result. Please also remember that pursuing a natural design rather than an overly aggressive one creates better outcomes in the long run.

If you are considering rhinoplasty, especially revision rhinoplasty, I recommend consulting with a surgeon who has extensive experience and specialized expertise. Based on anatomical knowledge as a board-certified otolaryngologist and extensive surgical experience, Dr. Peter C. Kang provides surgical plans tailored to each individual patient.

I will be with you every step of the way to achieve a beautiful and healthy nose.

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

Thank you.

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