Changes following nasal bridge skin necrosis after rhinoplasty and how reconstruction is performed

Hello, this is Dr. Peter C. Kang, medical director.

Today, I would like to introduce a nasal reconstruction case of a patient with nasal bridge skin necrosis and complex issues resulting from previous surgeries.

• 15 years ago: Silicone implant surgery

• 10 years ago: Ear cartilage grafting, silicone implant removal, alar reduction

• 9 years ago: Ear cartilage grafting → inflammation occurred

• Afterward: Total removal followed by AlloDerm (nasal bridge) and autologous buttock dermis (nasal tip) procedures

• Underwent various dermatological treatments (chemical peels, etc.) → skin became thin

• 5 years ago: Autologous rib cartilage and dermis grafting

• 6 to 7 years ago: Philtrum reduction, two-jaw (orthognathic) surgery (6 years ago)

Characteristics

• Traces of partial necrosis of the nasal bridge skin from previous surgeries

• Thinning of the dermal layer due to skin necrosis, with re-epithelialization following shedding of the epidermis

• Uneven surface on the nasal bridge due to dermis resorption

• Redness of the nasal tip skin caused by vascular compromise

• Asymmetry in left and right alar height

• Unusual nostril shape (^ ^ shape)

• Overall drooping shape of the alae

• Extensive scar tissue in the nasal tip from multiple operations

• History of using diverse graft materials

• Improvement of uneven areas along the nasal bridge

• Correction of left-right alar height symmetry

• Improvement of nostril shape (correction of ^ ^ shape)

• Alar elevation

Structural improvement

• Septal extension using autologous cartilage

• Autologous rib cartilage grafting in depressed areas

• Tissue-preserving approach to minimize further vascular damage

• Application of concentrated growth factors to facilitate recovery of damaged tissue

• Alar repositioning to refine nostril shape

• Correction of the nasolabial angle

Improvement in shape

• Smoothing of the nasal bridge surface

• Adjustment of alar height for bilateral symmetry

• Correction with alar elevation

• Creation of a natural nostril shape

Functional improvement

• Concurrent surgery for deviated septum and rhinitis to relieve nasal obstruction

Front view

• Significantly smoother nasal bridge surface

• Corrected left and right alar height

• Natural nostril shape

• Harmonious overall proportions

Profile view

• Substantial improvement in surface irregularities

• Establishment of appropriate height and length

• Improved nasolabial angle

• Balanced harmony with the philtrum

Nostrils

• Refined nostril shape

• Elevated alar position

• Balanced nostril shape

• Symmetrical nostril patency

This was an exceptionally complex case with a multi-layered history spanning more than 15 years, involving multiple rhinoplasties, various graft materials, and dermatological procedures. The most critical issue was partial necrosis of the nasal bridge skin from a past surgery. During the procedure, blanching of the nasal bridge skin confirmed that the microcirculation was severely compromised.

The irregularities along the nasal bridge resulted from the thinning of the dermis and loss of epidermis following necrosis; although re-epithelialization occurred, the overall skin thickness remained markedly reduced. Furthermore, the redness of the patient's nasal tip was attributed to impaired blood circulation stemming from vascular damage during earlier procedures.

To resolve these compounding issues, I took a meticulous approach while preserving as much normal tissue as possible. The depressed areas were carefully filled with autologous rib cartilage, and concentrated growth factors derived from the patient's own blood were applied to the compromised tissue to promote healing and support local circulation.

The asymmetry in alar height and the unusual nostril shape (arched like "^ ^") were improved naturally through precise adjustments to the lower lateral (alar) cartilages and alar elevation. In addition, without overlooking the functional aspects of the nose, 2 functional preservation procedures were performed concurrently to optimize breathing alongside the cosmetic improvements.

Even in such challenging cases involving skin necrosis and vascular compromise, a customized plan tailored thoughtfully to the patient's individual condition can successfully achieve both structural stability and aesthetic improvement.

This has been Dr. Peter C. Kang, medical director.

Thank you.

#closedrhinoplasty #revisionrhinoplasty #skinnecrosisrecovery #autologousribcartilage #growthfactortreatment #customrhinoplasty