Changes that occur when supporting the nasal tip with ear cartilage alone and reconstruction methods using rib cartilage

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient whose persistent nasal obstruction and crooked nose following prior surgery were improved through reconstruction using autologous rib cartilage.

6 to 7 years ago

• Alar reduction surgery

5 years ago

• Ear cartilage (nasal tip only) + osteotomy + dorsal hump correction

Functional issues

• Frequent nasal obstruction

• Deviated septum

• Chronic rhinitis

Aesthetic concerns

• A crooked-appearing nose

• Retracted columella (the columella is barely visible)

• Recurrent dorsal hump

• Protruding mouth findings

• An overly thinned nasal bridge

Special notes

• Functional issues persisting despite previous surgery

• Structural instability resulting from multiple surgeries

• Lack of nasal tip support

• Improve columellar show

• Correction of the crooked-appearing nose

• Recorrection of the dorsal hump

• Make the mouth appear less prominent (improving a protruding mouth)

• Prevent the nasal bridge from appearing too narrow

Structural reconstruction

• Full reconstruction using autologous rib cartilage

• Reinforcing the pre-existing unstable framework

• Precise realignment to correct the crooked nose

Improvement in shape

• Increased columellar show

• Recorrection of the dorsal hump

• Securing adequate nasal bridge width

• Creating a natural overall nasal contour

Functional improvement

• Fundamentally resolving nasal obstruction with septoplasty

• Improving rhinitis with inferior turbinate surgery

Correction of the nasolabial angle

• Improvement of protruding mouth

• An effect where the mouth appears less prominent

• Harmonious overall facial proportions

Functional improvement

• Complete relief of nasal obstruction symptoms

• Restoration of smooth breathing function

• Marked relief of rhinitis symptoms

Before surgery / Day 0 immediately after surgery Photos taken immediately after surgery show swelling and may differ from the final result.

Front view

• Corrected crooked nose

• A natural nasal bridge with appropriate width

• Balanced overall facial proportions

• Corrected dorsal hump

Before surgery / Day 0 immediately after surgery Photos taken immediately after surgery show swelling and may differ from the final result.

Profile view

• Improved columellar show

• Natural nasal tip position

• Improved nasolabial angle

• Softened appearance of a protruding mouth

Overall changes

• Stable nasal framework

• A natural and refined impression

• Harmonious overall facial proportions

Before surgery / Day 0 immediately after surgery Photos taken immediately after surgery show swelling and may differ from the final result.

This revision rhinoplasty case involved a patient who had persistent nasal obstruction and aesthetic concerns despite previous surgery. In particular, even after the surgery performed 5 years ago, frequent nasal blockage, a crooked nose, and a retracted columella persisted, requiring a fundamental solution.

A precise examination revealed that the previous surgery had not sufficiently addressed the functional issues, and that ear cartilage alone lacked the long-term structural stability needed to support the nasal tip. Furthermore, despite osteotomy and dorsal hump correction having been performed, the nose still appeared crooked and a residual dorsal hump remained.

To resolve these complex issues, a full reconstruction using autologous rib cartilage was planned. Because autologous rib cartilage provides significantly stronger support compared to ear cartilage, it allows for the correction of a crooked nose while supporting a stable result over the long term.

When correcting the crooked nose, both functional aspects and aesthetic concerns were addressed. Because a deviated septum was the primary cause of the nasal obstruction, it was accurately corrected to improve respiratory function. Inferior turbinate surgery was also performed concurrently to address the discomfort caused by chronic rhinitis.

Improving columellar show was a key priority for the patient. Due to retraction from the prior surgery, the columella was hardly visible; through meticulous reconstruction using autologous rib cartilage, a natural and appropriately defined columella was created.

For the dorsal hump recorrection, the areas that had not been fully addressed in the previous surgery were precisely refined. To address the patient's concern regarding an overly thinned bridge, an appropriate width was preserved while achieving a natural line.

By adjusting the nasolabial angle, an improvement in the appearance of a protruding mouth was also achieved, fulfilling the patient's goal of making the mouth appear less prominent.

As a result, both the functional and aesthetic concerns that remained unresolved from the previous surgery were comprehensively addressed. In particular, structural reconstruction using autologous rib cartilage provided long-term stability, and the patient is very satisfied.

This was a meaningful case demonstrating that issues persisting after previous surgery can be thoroughly resolved through accurate diagnosis and systematic reconstruction.

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

Thank you.

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