Examining the causes of a contracted nose and methods for reconstruction

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce a case where we resolved both a contracted nose and functional issues that developed after multiple surgeries.

• 2010: Silicone implant, ear cartilage surgery

• January 2024: autologous rib cartilage, silicone implant

• July 2024: reuse of rib cartilage, ear cartilage, silicone implant (followed by 7 procedures of hematoma/capsule aspiration and irrigation)

• August 2024: removal of silicone implant and rib cartilage

• Currently taking anti-contracture medication

• Improvement of contracted nose

• Functional impairment

• Improvement in left nasal obstruction

1. Front view

• Widened nasal dorsum

• Excessive nostril show

• Nostril asymmetry

• Short and deviated nose

2. Profile view

• Dorsal hump deformity (beak-like appearance)

• Upturned nose

• Retracted columella

3. Nostrils

• Left-right asymmetry

• Columella tilted to the left

• Bulbous nasal tip

This shows the condition of the septal cartilage confirmed during surgery. The first photo shows the currently damaged septal cartilage, and the area marked in white in the second photo represents the remaining septal cartilage. The area marked in yellow represents the expected original extent of the septal cartilage. Because a significant portion of the septum was damaged, it appears to have caused deformities such as an upturned nasal tip and a retracted columella.

To address these issues, the following procedures were performed:

1. Structural reconstruction

• Complete septal reconstruction using autologous rib cartilage

• Removal of contracted scar tissue

• Lower lateral cartilage reconstruction

• Lowering the left nostril rim

2. Shape improvement

• Correction of the widened bridge via lateral osteotomy

• Dorsal augmentation with autologous rib cartilage

• Correction of the upturned nose via septal extension

• Columellar reconstruction

• Correction of the nasolabial angle

3. Functional improvement

• Correction of deviated septum

• Radiofrequency submucosal resection of the inferior turbinate (rhinitis surgery)

In severe contracted nose reconstruction, the most critical step is to accurately identify the cause of contracture and thoroughly excise it. Contracted tissue should be excised as thoroughly as possible, and sufficient reconstruction of damaged cartilage must serve as the foundation, alongside meticulous postoperative management to prevent recurrent contracture.

In particular, the following treatments are actively considered to prevent re-contracture after surgery:

• Stem cell injection therapy

• Intravenous antibiotic therapy

• Hyperbaric oxygen therapy

• Helium laser therapy

A key characteristic of contracted nose reconstruction is that therapeutic and aesthetic aspects coexist. However, the top priority in this surgery is treatment and structural stabilization rather than mere cosmetic refinement. Just as a solid foundation is essential before building a beautiful structure, successful structural reconstruction greatly enhances the results of subsequent aesthetic procedures.

For this reason, in cases of severe contracted nose, it is common to take a staged approach dividing the process into a primary reconstructive surgery and a secondary aesthetic surgery. This is a strategic choice aimed at achieving a stable and reliable result with safety in mind.

I will continue to adhere to this systematic, specialized approach for the health and aesthetic outcome of our patients.

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

Thank you.

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