Nasal bridge depression and nostril asymmetry after multiple rhinoplasties: causes and reconstruction methods

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient whose complex deformity—involving skin damage and partial skin necrosis of the nasal bridge from multiple operations—was reconstructed using autologous rib cartilage.

• 23 years ago: silicone implant only at Asan Medical Center

• 20 years ago: Gore-Tex + ear cartilage + alar reduction

• 13 years ago: Gore-Tex + ear cartilage

• 10 years ago: nasal filler procedure

• 7 to 8 years ago: silicone implant + ear cartilage + septal surgery

• 3 to 4 months later: surgery performed due to nasal redness (exact details unclear)

1. Front view

• Excessive nostril show

• Nostril asymmetry

• Deviated nasal bridge

• Nasal bridge looking thin

2. Profile view

• Retracted columella

• Protruding mouth findings

• Unnatural nasal bridge line

3. Oblique view

• Depressed scar on the left nasal bridge (presumed to be from skin necrosis during a previous surgery)

4. Nostril view

• Apparent nostril asymmetry

• Columella deviated to the right

5. Function

• Left-sided nasal obstruction

• Correction of deviated nose

• Correction of nostril asymmetry

• Natural result

1. Septal reconstruction

• Severe septal cartilage damage confirmed

• Septal reconstruction using autologous rib cartilage

• Upturned nasal tip corrected with septal extension

2. Functional improvement

• Septoplasty

• High-frequency radiofrequency submucosal resection of the inferior turbinate (rhinitis surgery)

• Improvement in left nasal obstruction

3. Shape improvement

• Correction of nostril asymmetry

• Lowering the columella naturally

• Improvement of protruding mouth through nasolabial angle correction

• Straight bridge line

• Cartilage and acellular dermal matrix grafted to the depressed left nasal bridge

1. Front view

• Improvement of excessive nostril show

• Improvement of nostril asymmetry

• Straightened nasal bridge

• Appropriate nasal bridge width

2. Profile view

• Natural columellar line

• Improved nasolabial angle

• Smooth straight bridge line

3. Depressed area

• Depression on the left nasal bridge improved with cartilage and acellular dermal matrix grafts

4. Function

• Stable framework completed for the septal cartilage

• Balanced bilateral nasal cavity airway space

• Reduction in size of bilateral inferior turbinates

This was a complex case involving a history of multiple surgeries and depression specifically caused by skin necrosis on the left nasal bridge. The severe damage to the septal cartilage was addressed through septal reconstruction using autologous rib cartilage, while nostril asymmetry and the upturned nasal tip were also corrected.

In particular, volume was restored by grafting cartilage and acellular dermal matrix to the depressed area on the left nasal bridge, and the appearance of a protruding mouth was improved through nasolabial angle correction. Nasal obstruction was also resolved through septoplasty and inferior turbinate procedures, achieving satisfying results from both functional and aesthetic standpoints.

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

Thank you.

#closedrhinoplasty #revisionrhinoplasty #autologousribcartilage #bridgedepression #customrhinoplasty