Why cartilage shows through after multiple rhinoplasties and how to restore the mucosa and structure

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce the case of a patient who resolved complex issues stemming from multiple previous surgeries and revisions through reconstruction with autologous rib cartilage.

5 years ago

• Septal cartilage + ear cartilage + silicone implant

• Outcome: Drooping nasal tip

3 to 4 years ago

• Donor rib cartilage + silicone implant + ear cartilage + alar reduction

• Outcome: Silicone implant mobility occurred

Afterward

• Revision surgery 6 months later

• Second revision surgery 6 months later

Functional issues

• Chronic nasal obstruction

• Rhinitis symptoms

• Impaired respiratory function

Damage from multiple surgeries

• Thinned mucosal state

• Lateral cartilage show-through (nasal tip)

• Nostril asymmetry

• Overall tissue damage

Aesthetic concerns

• Philtrum appears long

• Low nasal tip relative to nasal bridge height

• Overall nasal proportion imbalance

Special notes

• Tissue fatigue from multiple surgeries and revisions

• Decreased healing capacity due to mucosal damage

• Complex structural problems

• Recovery of mucosal damage

• Correction of lateral cartilage show-through

• Correction of nostril asymmetry

• Making the philtrum appear shorter

• Desire to elevate the tip even if lowering the bridge

Mucosal and tissue restoration

• Reinforcing thinned mucosa

• Promoting regeneration of damaged tissue

• Establish a stable healing environment

Resolving cartilage show-through

• Complete correction of lateral cartilage show-through

• Restoring nasal tip skin thickness

• Achieving a natural tip shape

Structural reconstruction

• Full reconstruction using autologous rib cartilage

• Appropriately adjusting nasal bridge height

• Improving overall proportions by elevating the nasal tip

Asymmetry correction

• Precise correction of nostril asymmetry

• Balanced nasal contours

• Achieving natural symmetry

Proportion adjustment

• Visually shortening the philtrum through nasolabial angle correction

• Harmonious proportion between bridge and tip

• Balanced harmony with the entire face

Functional improvement

• Fundamentally resolving nasal obstruction with septoplasty

• Improving rhinitis with inferior turbinate surgery

Functional improvement

• Complete relief of nasal obstruction

• Marked relief of rhinitis symptoms

• Restoration of smooth breathing function

Improvement in tissue condition

• Restoration of mucosal thickness

• Complete resolution of lateral cartilage show-through

• Establishing a healthy internal nasal environment

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

Front view

• Corrected nostril asymmetry

• Natural nasal tip shape

• A clean nasal tip without cartilage show-through

• 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

• Appropriately adjusted nasal bridge height

• Improved proportions with an elevated nasal tip

• Visual shortening effect on the philtrum

• Harmonious facial profile

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

Overall changes

• Resolution of complications from multiple surgeries

• The desired aesthetic proportions requested by the patient

• A healthy and natural-looking nose

• Long-term stable outcome

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 re-injury risks through mucosal recovery

• Lasting and natural results

This was a complex case requiring the resolution of multiple issues accumulated over 5 years of repeated surgeries and revisions. In particular, mucosal thinning and lateral cartilage show-through are typical side effects of excessive surgical interventions, necessitating a very careful approach.

The most significant concern for the patient was the thinning of the internal nasal mucosa due to multiple procedures. When the mucosa thins, it becomes vulnerable to external trauma, potentially causing dryness or bleeding, and most importantly, cartilage show-through becomes cosmetically prominent.

Cartilage show-through occurs when the overlying skin and mucosa of the nasal tip thin, allowing the underlying cartilage structure to become visible externally. This is not solely an aesthetic issue; it can also increase the long-term risk of skin breakdown or infection, making it an essential concern to address.

The patient's specific request to elevate the tip even if the bridge had to be lowered was technically demanding. Generally, the bridge and tip form a continuous structure, meaning changes to one component inherently affect the other. Resolving this required meticulous planning and delicate technique.

In this reconstruction using autologous rib cartilage, the core objectives were reinforcing the thinned mucosa, resolving the lateral cartilage show-through, and delivering the proportions desired by the patient. Securing sufficient soft tissue thickness at the nasal tip was essential to prevent visible cartilage while forming a natural tip shape.

Correcting nostril asymmetry was another vital step. The asymmetry resulting from previous operations was precisely adjusted to restore bilateral balance.

Through nasolabial angle correction, a visual shortening effect on the philtrum was achieved, fulfilling the patient's request. Concurrently, the bridge height was adjusted appropriately while elevating the tip to realize balanced proportions.

The most crucial priority was restoring damaged tissue. Deliberate surgical techniques and careful recovery management were applied to allow tissues stressed by repeated surgeries to heal healthily.

As a result, all complications stemming from multiple surgeries over 5 years were addressed successfully. The mucosa recovered, lateral cartilage show-through resolved, and the desired proportions and shape were achieved, leaving the patient very satisfied.

This case demonstrates that even complicated and challenging revision cases can be resolved thoroughly through precise diagnosis and a systematic treatment plan.

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

Thank you.

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