Septal perforation and nasal tip cartilage show-through after repeated rhinoplasties: how reconstruction is performed

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who resolved complex issues stemming from multiple surgeries and inflammation over 14 years through autologous rib cartilage reconstruction.

14 years ago

• Gore-Tex + ear cartilage

13 years ago

• Silicone implant + alar reduction + osteotomy

12 years ago

• Removal at the glabella due to inflammation

10 years ago

• After implant removal, filler treatment along the entire nasal bridge and nasal tip

9 years ago

• After filler removal, silicone implant + ear cartilage + alar reduction

Recently

• Silicone implant + ear cartilage

• Dermis procedure (buttock dermis) on the nasal tip only

Functional issues

• 7x9 mm septal perforation

• Severe damage to the septal cartilage

• Chronic rhinitis

• Impaired respiratory function

Aesthetic concerns

• Cartilage show-through due to thinned nasal tip skin

• Protruding mouth findings

• Nostril asymmetry

Special notes

• 7 repeated surgeries over 14 years

• Tissue damage due to inflammation

• Nasal tip skin thinned as packed cartilage pieces became tangled together

• Limitations in correction due to previous alar reduction

• Improvement of awkwardness caused by a protruding mouth

• Natural nasal shape

• Resolution of functional problems

• Stable results

Septal reconstruction

• Septal reconstruction using autologous rib cartilage for severely damaged septal cartilage

• Correction of the 7x9 mm septal perforation

Structural reconstruction

• Full reconstruction using autologous rib cartilage

• Trimming and restructuring tangled existing cartilage

• Dermal graft to restore nasal tip skin thickness

Improvement in shape

• Improvement of protruding mouth through nasolabial angle correction

• Restoration of a natural philtrum angle

• Creating a natural overall nasal contour

Functional improvement

• Restoring respiratory function with septoplasty

• Improving rhinitis with inferior turbinate surgery

Managing limiting factors

• Explanation of limitations in correcting nostril asymmetry due to previous alar reduction

• Maximizing improvement within the feasible range

Functional improvement

• Complete closure of the septal perforation to restore respiratory function

• Marked relief of rhinitis symptoms

• Stable internal nasal framework

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

Front view

• Natural overall nasal contour

• Balanced facial proportions

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

Profile view

• Improved protruding mouth

• Natural nasolabial angle

• Natural transition between the philtrum and columella

• Harmonious facial profile

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

Nostrils

• Improved nostril symmetry (within structural limits)

Nasal tip condition

• Improvement of cartilage show-through

• Restoration of adequate skin thickness

• Natural nasal tip shape

Long-term stability

• Long-term stability using autologous rib cartilage

• Minimizing the risk of revision surgery

This case involved a patient whose nasal condition became highly complex due to 7 repeated surgeries and bouts of inflammation over 14 years. In particular, it was a challenging case compounded by a 7x9 mm septal perforation, severely damaged septal cartilage, and complex structural deformities in the nasal tip.

The highest priority was correcting the 7x9 mm septal perforation. A perforation of this size significantly impairs breathing, and because the existing septal cartilage was severely damaged, complete septal reconstruction using autologous rib cartilage was necessary. Fortunately, the septal perforation was closed entirely, restoring normal respiratory function.

At the nasal tip, cartilage pieces packed in during previous procedures had become tangled together, thinning the skin and causing visible cartilage show-through. This was not only an aesthetic concern, but it also posed a long-term risk of skin breakdown that needed to be addressed. The problematic existing cartilage was trimmed and reorganized, a new, stable framework was constructed using autologous rib cartilage, and a dermis graft was placed to restore skin thickness.

The awkward appearance from a protruding mouth, which was a major concern for the patient, was improved by correcting the nasolabial angle. Correcting the nasolabial angle created a natural connection between the philtrum and the columella, enhancing overall facial harmony.

Regarding nostril asymmetry, I explained thoroughly before surgery that previous alar reduction procedures placed limitations on achieving complete symmetry. Nevertheless, we achieved significant improvement within the feasible range to deliver a natural outcome.

Although the patient had suffered through 7 surgeries over 14 years, systematic reconstruction with autologous rib cartilage resolved both the functional and cosmetic concerns. In particular, the septal perforation was closed completely to restore normal breathing function, and the natural contour from the philtrum to the columella was achieved, leaving the patient very satisfied.

This case meaningfully demonstrates that even the most complex and demanding revision rhinoplasties can achieve successful results through accurate diagnosis, systematic planning, and the appropriate selection of graft materials.

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

Thank you.

#closedrhinoplasty #revisionrhinoplasty #autologousribcartilage #septalperforationrepair #protrudingmouthcorrection #customrhinoplasty