Why donor dermis absorbs after multiple revision surgeries and how to reconstruct the septum

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

Today, I would like to share a reconstruction case of a patient with a history of 6 surgeries over 14 years, who suffered from complex issues caused by donor dermis absorption and septal cartilage damage.

• 14 years ago: Silicone implant + ear cartilage surgery → Silicone implant show-through at the tip, nasal bridge deviation

• 12 years ago: Additional ear cartilage harvest with silicone implant → Dissatisfaction with design

• 10 years ago: Silicone implant + donor rib cartilage + ear cartilage surgery → Dissatisfaction with overly sharp shape

• 9 years ago: Silicone implant + donor rib cartilage + buttock dermis → Satisfied with the shape, but inflammation occurred

• 9 years ago (2 weeks later): Total removal surgery due to inflammation

• 3 years ago: Donor dermis (nasal bridge) + autologous rib cartilage surgery

Functional issues

• Difficulty breathing when lying on the right side

Aesthetic concerns

• Lowered nasal dorsum due to partial absorption of donor dermis on the bridge

• Unnatural profile line due to an elevated radix starting point

• Deviation to the right on front view

• Pointed nasal tip

• Severe damage to the septal cartilage

• Columella tilted to the right

• Nostril asymmetry

Special notes

• Thin nasal bridge skin due to 6 surgeries

• Tissue damage from past history of inflammation

• Refining the sharp nasal tip (making it rounded and voluminous)

• Lowering the glabella height

• Making the nose appear shorter (without looking upturned)

• Natural result

• Lowering the columella

• Improvement of protruding mouth

Skin and tissue reconstruction

• Removal of partially absorbed donor dermis on the nasal bridge

• Reinforcing thinned nasal bridge skin with retroauricular dermis

• 3 sessions of stem cell therapy

Structural reconstruction

• Reconstruction of the damaged septal cartilage using autologous rib cartilage

• Correction of the rightward deviation seen on front view

• Softening the overly sharp nasal tip

• Correction of columellar tilting and nostril asymmetry

• Adjustment of glabella radix

• Correction of the nasolabial angle

Functional improvement

• Septoplasty and inferior turbinate surgery (rhinitis surgery) to improve breathing function

Functional improvement

• Resolution of breathing difficulty when lying on the right side

• Overall improvement in breathing function

Front view

• Natural nasal bridge height

• Correction of the rightward deviation

• Rounded, voluminous nasal tip

• Straightened columellar position

• Improved nostril symmetry

Profile view

• Lowered glabella radix

• Natural profile line

• Adequate nasal length

• Improvement of protruding mouth

Nostrils

• Correction of the tilted columella

• Correction of nostril asymmetry

This was a complex case involving a patient with a history of 6 nasal surgeries over 14 years. In particular, after undergoing total removal surgery due to inflammation 9 years ago and subsequent reconstruction with donor dermis and autologous rib cartilage 3 years ago, partial absorption of the donor dermis and severe damage to the septal cartilage were the primary issues.

The donor dermis used on the nasal bridge had partially absorbed, lowering the dorsum and making the radix starting point appear too high, resulting in an unnatural profile line. Additionally, the nose deviated to the right on front view, and the nasal tip appeared sharp. To address these problems, the absorbed donor dermis was removed, the radix starting point was lowered appropriately to create a natural profile line, the frontward deviation was corrected, and the sharp tip was softly refined.

Furthermore, because repeated surgeries had left the skin of the nasal bridge quite thin, skin reinforcement using retroauricular dermis was performed concurrently. This was an essential step for supporting stable, long-term results.

Most importantly, the severely damaged septal cartilage was reconstructed using autologous rib cartilage. Through this reconstruction, the rightward columellar tilt and nostril asymmetry caused by the compromised septum were fundamentally resolved.

We were able to fulfill the patient's requests: creating a rounded, voluminous nasal tip instead of a sharp one, achieving a natural nasal length, and improving columellar visibility. By adjusting the nasolabial angle, the appearance of a protruding mouth was also improved, resulting in a satisfying outcome that addressed the patient's concerns comprehensively.

Even in complex cases involving multiple revisions and past inflammation, this case stands as a meaningful example of fulfilling diverse patient goals through fundamental structural reconstruction and meticulous skin management.

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

Thank you.

#closedrhinoplasty #multiplerevisionrhinoplasty #donordermisabsorption #septalreconstruction #stemcelltherapy #customrhinoplasty