How the septum is reconstructed in revision rhinoplasty

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce a tailored revision rhinoplasty case involving septal reconstruction for a patient with a complex surgical history.

• 2007: Two-jaw surgery

• 2008: Silicone implant and septal cartilage surgery

• 2016–2018: Orthodontic treatment

• 2018: Alar reduction surgery

• 2020: 3-piece facial contouring surgery

• Past: Nasal filler procedures

The patient preferred a glamorous aesthetic and did not want osteotomy.

• Correction of a small, crooked nose

• Correction of nostril asymmetry

• Improvement of breathing function

• Desire for a change toward a glamorous appearance

1. Septal reconstruction using autologous rib cartilage

2. Lowering the columella and correcting the nasolabial angle

3. Septal extension graft

4. Foreign material removal

Appearance after foreign material removal

5. Additional surgery for functional improvement (septoplasty and radiofrequency laser submucosal resection of the inferior turbinate)

1. Front view

• The radix appears high and widened due to residual nasal filler

• Asymmetry of the glabella, nasal bones, and alae

• Deviated nasal bridge

• Blunt and broad nasal tip

2. Profile view

• High radix starting point

• Retracted columella

• Protruding mouth findings

3. Nostrils

• Asymmetry resulting from alar reduction surgery

• Columella tilted to the right

• Nasal tip deviated to the right

1. Front view

• Radix lowered naturally following removal of nasal filler

• Crooked nose corrected through improvement of nasal bone asymmetry

• Deviation of the nasal tip has also improved

• Alar asymmetry significantly improved

2. Profile view

• Radix lowered naturally

• Improvement of the drooping nasal tip

• Refined profile line

• Improvement of protruding mouth through nasolabial angle correction

3. Oblique view

• Added three-dimensional contour to a previously flat facial appearance

• Nasal tip refined and corrected

• Improvement of protruding mouth

4. Nostril correction

• Achieving bilateral symmetry

• Correction of columellar deviation

• Improvement in alar asymmetry

This case involved resolving multiple complex issues resulting from a diverse surgical history. In particular, taking into account the tissue changes caused by prior filler and multiple surgeries including two-jaw surgery, a stable reconstruction was performed using autologous tissue.

Because two-jaw surgery involves surgical areas adjacent to the septal cartilage, changes in nasal shape can occur after surgery. By reconstructing the damaged septal cartilage with autologous rib cartilage, we were able to create the glamorous, refined appearance the patient desired. This was made possible through accurate problem analysis and meticulous surgical planning.

The overall appearance improved into the glamorous yet natural look the patient wanted, and breathing function was also enhanced, leading us to expect high patient satisfaction.

I hope this case is helpful to those facing similar concerns.

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

Thank you.

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