Why the septum collapses after multiple revision rhinoplasties, and how total reconstruction is performed with autologous rib cartilage

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce the case of a patient with a very complex surgical history. Having gone through multiple revision surgeries, the patient endured a great deal of hardship, and I was truly pleased that we were finally able to achieve a satisfying result.

It was indeed a surgical journey spanning a long period.

• 19 years ago: First surgery to correct an arrow nose

• 10 years later: Second surgery for design adjustment • Gore-Tex implant used → Inflammation developed 5 years later

• 3 years ago: Implant removal

• 2 years ago: Revision rhinoplasty with silicone implant + donor dermis

• 1 year ago: Revision rhinoplasty and columella reconstruction

• 5 months ago: Another revision rhinoplasty

Preoperative status: Septal perforation present, requiring endoscopic evaluation

Having undergone so many surgeries, the patient's requests were truly earnest.

• Above all, a natural nasal shape

• Improvement of the retracted columella

• Resolution of the implant/cartilage extruding inside the nose

• A stable result without further problems

This type of case was very challenging, as almost no native septal cartilage remained.

Main surgical procedures:

1. Complete septal reconstruction

• Total reconstruction of the septum using autologous rib cartilage

• Complete restoration of the missing cartilage structure

2. Removal of extruded material and mucosal restoration

• Removal of cartilage fragments from previous surgery protruding through the right mucosa

• Meticulous repair of the damaged mucosa

3. Treatment of septal perforation

• Identification of a 7 mm perforation

• Closure of the perforation using ear perichondrium

4. Reconstruction of lower lateral cartilages

• Bilateral loss of lower lateral cartilages

• Complete reconstruction with autologous rib cartilage

5. Dorsal height adjustment

• Considering the condition of the mucosa, instead of a silicone implant,

• A safe approach using only autologous rib cartilage

※ Notable point: In this type of case, to minimize the risk of inflammation, all areas were operated on using only autologous rib cartilage.

At the end of this long and complex journey, a truly satisfying result was achieved.

Areas improved:

• Achievement of a natural and aesthetically pleasing nasal line

• Appropriate shortening of an excessively long nose

• Refinement of a blunt nasal tip

• Correction of nostril asymmetry

• Natural restoration of the retracted columella

I felt deeply rewarded when the patient told me immediately after surgery, "It finally feels like my own nose."

Handling such a complex revision case allowed me to reaffirm several key principles.

The challenges of revision rhinoplasty:

When normal tissue is severely damaged from multiple surgeries, a straightforward approach is not possible. In particular, when almost no septal cartilage remains

and the lower lateral cartilages are also lost, comprehensive reconstruction is essential.

The importance of autologous tissue:

For patients with a history of inflammation, autologous tissue must be prioritized over artificial implants. Even if it makes the surgery more complex, it is a necessary choice for long-term stability.

Precise diagnosis and planning:

Identifying the septal perforation in advance through preoperative endoscopy and incorporating it into the surgical plan was key to success. Only with such thorough preparation can unexpected complications be prevented.

Even in such difficult cases, we do not give up and strive for the intended result. I hope this case brings hope to those facing similar concerns.

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

#closedrhinoplasty #closedrevisionrhinoplasty #autologousribcartilage #septalreconstruction #alarreconstruction #revisionspecialist #revisionrhinoplasty