How rib cartilage reconstruction is done when the septum is damaged after multiple surgeries

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce the case of a patient who visited our clinic after undergoing five previous nasal surgeries and suffering from severe septal damage.

• 30 years ago: L-shaped silicone implant

• 28 years ago: L-shaped silicone implant (crooked nose correction)

• 15 years ago: Ear cartilage + silicone implant

• 10 years ago: Ear cartilage + silicone implant

• 10 years ago: Autologous rib cartilage (deep temporal fascia + rib cartilage on the nasal bridge)

• 5 years ago: Columellar filler procedure

• I want the shape of my nasal tip to look natural.

• I want the columellar filler removed so my columella looks natural.

• I want to lower the radix.

• I want a natural height that is not excessively high.

• I want an overall softer impression.

In this surgery, the core objectives were reconstructing the severely damaged septum and repurposing existing tissue to create a natural nasal tip.

1. Foreign material removal and tissue evaluation

• Complete removal of the columellar filler injected 5 years ago

• Assessment of the deep temporal fascia from the previous surgery

• Detection of obliquely crooked deep temporal fascia

• Detailed evaluation of the extent of septal damage

2. Septal reconstruction using autologous rib cartilage

• Confirmation of severe septal damage during surgery

• Immediate decision to harvest autologous rib cartilage

• Reconstruction of the damaged septum using autologous rib cartilage

• Securing structural stability for the central framework of the nose

• Improvement of breathing function

3. Repurposing deep temporal fascia

• Removal of the previously grafted, obliquely positioned deep temporal fascia

• Repurposing the removed fascia to reinforce the skin over the nasal tip

• Thickening and reinforcing the thin nasal tip skin

• Preserving a natural feel to the touch

• Minimizing tissue wastage

4. Natural nasal tip reconstruction

• Focusing on creating a natural nasal tip shape

• A soft tip without a pinched appearance

• An appropriate height that is not excessive

• Harmony with the overall face

• An elegant tip contour

5. Adjusting the radix

• Lowering the radix to achieve natural proportions

• Improving the overall balance of nasal length

• A smooth transition line from the forehead to the nose

• Harmonious facial proportions

6. Nasolabial angle correction

• Establishing an appropriate nasolabial angle

• Natural profile line

• An elegant profile silhouette

• A natural columellar position

Front view changes:

• The nasal tip was refined naturally

• The radix was lowered for harmonious proportions

• A soft tip without a pinched appearance

• Enhancing overall facial balance

• A natural and refined frontal profile

Profile changes:

• Improved to a natural nasal height

• An elegant profile achieved by correcting the nasolabial angle

• Soft nasal tip line

• A natural transition from the radix to the nasal tip

• A refined and harmonious lateral silhouette

Nostril view changes:

• A natural columella after removal of the columellar filler

• Improvement in nasal tip shape

• Achieving bilateral balance

• Alignment of the columellar midline

• Natural nostril shape

Revision rhinoplasty for a patient with a history of five surgeries requires an exceptionally careful approach. In this case in particular, the septal damage was much more severe than anticipated.

When examining the septum during surgery, it was severely damaged from the prior procedures, and I determined that a stable nasal structure could not be achieved in that condition. I promptly explained the situation to the patient and guardian, informing them of the need to reconstruct the septum using autologous rib cartilage.

Autologous rib cartilage is an ideal material for septal reconstruction. It provides sufficient strength and volume to completely reconstruct a damaged septum. Because the septum serves as the central framework and main support structure of the nose, rebuilding it solidly is critical for long-term stability.

An interesting finding was that the deep temporal fascia used in the surgery 10 years ago had been grafted in an obliquely crooked position. Rather than discarding it, I repurposed it to reinforce the nasal tip skin. Fascia is an effective material for reinforcing tissue, which becomes especially important when the skin has thinned after multiple surgeries.

The primary focus in this surgery was creating a natural nasal tip. This was what the patient desired most, and considering the history of five surgeries, I also judged that natural refinement was far more important than excessive correction.

I meticulously adjusted the framework to achieve an orderly tip without a pinched look, an elegant height without being overly prominent, and a refined line that did not look artificial. By lowering the radix, the overall balance of nasal length was improved, and the nasolabial angle was appropriately adjusted to complete an elegant lateral silhouette.

Revision rhinoplasty for patients who have undergone multiple surgeries is considerably more complex and challenging than primary surgery. One must manage compromised tissues, clear away scar tissue, and make the most of the remaining healthy tissue. Nevertheless, with an accurate diagnosis, systematic planning, and meticulous surgical technique, we were able to deliver the natural result the patient wanted.

I will continue to provide customized surgeries that reflect each patient's individuality and requests through this meticulous approach. I hope this helps those with similar concerns.

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

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