Supportive structures in a contracted nose and revision rhinoplasty using autologous rib cartilage

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce a case in which contracted nose complications following multiple rhinoplasty surgeries were addressed.

Surgical history:

• First surgery: silicone implant + ear cartilage + alar reduction

• Second surgery: revision rhinoplasty using autologous rib cartilage

• Third surgery: touch-up revision surgery

• Nostrils that appear upturned

• Excessively high bridge

• Need for scar revision

• Difficulty breathing

Front view: Upturned nasal tip, nostril asymmetry

Profile view: Pointed and upturned nasal tip

Nostril view: Columella tilted to the left, asymmetric and excessively long nostrils, scarring on the left columella

Nasal obstruction: Deviated septum, external nasal valve stenosis

1. Septal reconstruction using autologous rib cartilage: The septal cartilage damaged from prior surgeries was sturdily reconstructed using autologous rib cartilage. Through this reconstruction, the upturned nasal tip could be lowered naturally.

2. Removal of inflammatory granulation tissue from the nasal tip: This was the step requiring the utmost care during the surgery. Residual inflammatory tissue in the nasal tip was completely removed.

3. Correcting frontal asymmetry through nostril lowering: Nostril lowering was performed to correct nostril asymmetry and improve nostril shape.

4. Lowering the columella naturally

5. Reconstruction, repositioning, and suture binding of the lower lateral cartilages to correct nostril asymmetry

6. Lowering the nasal tip height to achieve a more natural appearance for overly long nostrils

7. External nasal valve reconstruction: External nasal valve stenosis is a direct cause of nasal obstruction. Surgery was performed to widen the external nasal valve and relieve nasal obstruction.

The sharp tip became much more natural, and the decreased nasolabial angle noticeably improved the upturned profile appearance. Most remarkably, the nostrils that once appeared pointed now look much more natural.

For this type of case, proactive intravenous antibiotic therapy is planned to manage postoperative tip inflammation, alongside stem cell therapy to help prevent re-contracture. If needed after 6 months, an additional procedure to refine symmetry may be considered.

Surgery for a contracted nose caused by inflammation requires a stepwise and systematic approach. Rather than attempting to resolve every concern in a single operation, managing inflammation, reconstructing structural support, and proceeding through detailed refinements allows us to achieve the intended result.

Based on extensive experience and specialized expertise in complex revision cases, we offer the most appropriate surgical plan.

If you are considering revision rhinoplasty, please consult with an experienced specialist to establish a treatment plan that suits your specific condition.

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

Thank you.

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