Why the nose keeps deviating after multiple surgeries and methods for septal cartilage reconstruction

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce the case of a patient whose nose continued to deviate and whose nostril asymmetry remained uncorrected despite undergoing multiple surgeries over a period of 30 years.

1990 (age 31)

• L-shaped silicone implant

2008 (age 49)

• Medpor, ear cartilage, and silicone implant

2012 (age 53)

• Ear cartilage + silicone implant

2013

• Ear cartilage + silicone implant

2015

• Ear cartilage + silicone implant

2018

• Ear cartilage, silicone implant, and alar reduction

Persistent problems

• A nose that continued to deviate even after 6 surgeries over 30 years

• Uncorrected nostril asymmetry

• Structural issues that did not improve despite repeated revisions

Analysis of root causes

• Severely deviated septal cartilage

• Severe damage to the septal cartilage caused by previous surgeries

• Collapse of the septal structure itself, which serves as the central pillar of the nose

• Continuous nasal deviation and nostril asymmetry resulting from the compromised pillar

Functional issues

• Impaired breathing function due to structural instability

• Chronic rhinitis

Special notes

• Fundamental structural problems unresolved despite 6 surgeries over 30 years

• A condition impossible to correct without septal cartilage reconstruction

• Naturally defined, prominent nose

• Maintaining moderate height

• Improvement of protruding mouth

• Resolving fundamental problems

Key point: septal cartilage reconstruction

• Complete reconstruction of the septal cartilage using autologous rib cartilage

• Replacement of damaged and deviated preexisting septal cartilage

• Establishment of a stable structure serving as the central pillar of the nose

Structural reconstruction

• Full reconstruction using autologous rib cartilage

• Securing nasal tip stability through lower lateral cartilage reconstruction

• Restoring the entire structure damaged by 30 years of repeated surgeries

Improvement in shape

• Fundamental correction of the crooked nose

• Improvement of nostril asymmetry

• Maintaining a natural height

• Improvement of protruding mouth through nasolabial angle correction

Functional improvement

• Restoring respiratory function with septoplasty

• Improving rhinitis with inferior turbinate surgery

Fundamental improvement

• Thorough correction of the crooked nose that remained unresolved for 30 years

• Significant improvement in nostril asymmetry

• Establishment of a stable central nasal axis

Functional improvement

• Restoration of smooth breathing function

• Marked relief of rhinitis symptoms

• A structure that remains stable over the long term

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

• Improved nostril symmetry

• Natural height

• Balanced overall 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

• Harmonious facial profile

• Natural nasal line

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

Functional improvement

• Restoration of smooth breathing function

• Marked relief of rhinitis symptoms

• A structure that remains stable over the long term

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

Long-term stability

• Long-term stability using autologous rib cartilage

• Minimizing the risk of revision surgery

• Lasting results achieved by addressing the underlying structure

This presentation was a very unique case where nasal deviation persisted and nostril asymmetry remained uncorrected despite 6 surgeries spanning 30 years. The patient had undergone procedures at several clinics over an extended period without finding a fundamental solution, and came to our clinic with significant distress.

Following detailed examinations and analysis, the core issue was found to be severe damage and deformation of the septal cartilage. The septal cartilage, which serves as the central axis of the nose, had not only been severely deviated from the start, but was also severely compromised by previous surgical interventions.

Comparing the nasal structure to a building, the septal cartilage functions as the central support pillar. If this pillar is bent or compromised, no matter how much the exterior walls are repaired or decorated, the entire building inevitably tilts and remains unstable. Similarly, unless the septal cartilage is properly reconstructed, the nose will continue to deviate and nostril asymmetry will persist, regardless of how many procedures are performed.

To address this fundamental issue, complete reconstruction of the damaged septal cartilage was essential. By reconstructing the entire septal cartilage anew using autologous rib cartilage, we were able to stably re-establish the central axis of the nose.

While preserving the natural yet refined look requested by the patient without exaggeration, we also performed nasolabial angle correction to improve the appearance of the protruding mouth. This helped enhance overall facial balance.

As a result, we were able to fundamentally resolve the crooked nose and nostril asymmetry that had persisted for 30 years. Above all, because a stable framework was established through septal cartilage reconstruction, we can expect lasting results over the long term.

This case was meaningful in demonstrating the importance of fundamental structural analysis and systematic reconstruction rather than simple aesthetic modification. It confirmed that even with complex, long-standing issues, successful outcomes can be achieved through accurate identification of the cause and an appropriate surgical plan.

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

Thank you.

#closedrhinoplasty #revisionrhinoplasty #autologousribcartilage #septalcartilagereconstruction #crookednosecorrection #nostrilasymmetrycorrection #customrhinoplasty