Problems caused by excessive harvest of septal cartilage and methods for reconstruction

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

Today, I would like to introduce a case of reconstructing structural instability caused by excessive septal cartilage harvest in a patient who had undergone 3 nasal surgeries over 18 years.

• 2012: Right zygomatic fracture surgery

• 18 years ago: Ear cartilage + silicone implant surgery → deviated to one side

• 10 years ago: Ear cartilage + silicone implant + septal cartilage surgery → deviated to the opposite side, show-through phenomenon

• 2 years ago: Autologous rib cartilage + silicone implant + ear cartilage surgery

Functional issues

• Rhinitis symptoms

Aesthetic concerns

• Nasal tip appears short

• Nostril asymmetry

• Nose appearing crooked

• Issues with columella and nasolabial angle

Structural issues (confirmed during surgery)

• Excessive harvest of septal cartilage in previous surgeries, including the bony portion of the septum

• Severe impairment of septal stability

• Tip shortening and nostril asymmetry due to structural instability

• Improvement of the shortened nasal tip

• Evaluation and treatment of rhinitis

• Improvement of nostril asymmetry

• Correction of the columella and nasolabial angle

Septal reconstruction

• Addressing the deficiency of excessively harvested septal cartilage

• Solid reconstruction of the septum using autologous rib cartilage

• Securing septal stability

Structural improvement

• Septal extension using autologous rib cartilage

• Restoration of shortened tip length

• Correction of the crooked-appearing nose via lateral osteotomy of the nasal bones

• Improvement of nostril asymmetry

Morphological improvement

• Naturally lowering the columella

• Refined correction of the nasolabial angle

Functional improvement

• Improvement of rhinitis through septoplasty and radiofrequency submucosal turbinoplasty of the inferior turbinates

Functional improvement

• Alleviation of rhinitis symptoms

• Smooth breathing function

Front view

• Crooked-appearing nose corrected through lateral osteotomy

• Well-balanced nostril symmetry

• Stable nasal framework

Profile view

• Restored nasal tip length

• Naturally lowered columella

• Nicely corrected nasolabial angle

• Harmonious profile line

Structural stability

• Sturdy septal reconstruction

• Long-term stable nasal shape

This patient had undergone 3 nasal surgeries over 18 years, and structural instability caused by excessive harvest of septal cartilage was the primary concern.

The most significant intraoperative finding was that a very large amount of septal cartilage, extending into the bony portion of the septum, had been harvested during prior surgery.

Septal cartilage serves as the central support structure of the nose; it was determined that excessive harvesting had weakened this support, resulting in tip shortening and nostril asymmetry.

Excessive harvesting of septal cartilage affects not only aesthetics but also the overall structural stability of the nose. Over time, this can alter the nasal shape and trigger a cascade of structural issues.

To resolve this fundamental problem, the septum was solidly reconstructed using autologous rib cartilage.

Using a sufficient amount of autologous rib cartilage, the deficient septal framework was reinforced, restoring the central support of the nose.

Along with septal reconstruction, septal extension was performed to restore the shortened tip length and improve the nostril asymmetry caused by the unstable structure.

In addition, the crooked-appearing nose was corrected through lateral osteotomy of the nasal bones to establish a stable central axis.

By naturally lowering the columella and refining the nasolabial angle, the harmony of the profile line was also improved.

Functionally, septoplasty and radiofrequency submucosal resection of the inferior turbinate were performed concurrently to address rhinitis and improve breathing function.

By addressing the root cause—structural instability caused by excessive septal cartilage harvest—this served as an important reconstructive case where the shortened nasal tip and nostril asymmetry were corrected simultaneously, securing a stable long-term result.

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

Thank you.

#closedrhinoplasty #septalreconstruction #excessivecartilageharvest #structuralinstability #autologousribcartilage #customrhinoplasty