Why nasal obstruction and a crooked nose can persist even after multiple surgeries

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who visited our clinic troubled by persistent nasal obstruction and a crooked nose despite having undergone multiple surgeries.

5 years ago: Rhinoplasty using ear cartilage along with alar reduction

• Unfortunately, the patient did not notice much of a change.

2 years ago: Revision rhinoplasty using autologous rib cartilage, a silicone implant, and ear cartilage, along with alar reduction

• There was some improvement, but the outcome remained unsatisfactory.

3 months ago: Philtrum reduction

Despite two nasal surgeries, the patient continued to struggle with the following issues:

1. Severe nasal obstruction: Significantly worse on the right side than on the left

2. Crooked nose: Visible facial asymmetry due to leftward septal deviation

3. Rhinitis symptoms: Chronic nasal congestion and breathing discomfort

4. Anxiety regarding revision surgery: Disappointment over the results of previous procedures

In this patient's case, the septum had become substantially weakened. This was not a situation where simply altering external appearance would suffice; fundamental structural correction was required.

1. Septal reconstruction using autologous rib cartilage

• Robust reconstruction of the weakened septum

• Securing a stable support structure using autologous rib cartilage

• Establishing a long-term, stable nasal framework

2. Lateral nasal bone osteotomy

• Precise correction of deviated nasal bones

• Achieving bilateral symmetry

• Creating a natural nasal profile line

3. Septoplasty

• Correction of the leftward-deviated septum

• Restoring internal nasal volume balance

• Enhancement of structural stability

4. Radiofrequency submucosal resection of the inferior turbinates

• Improving nasal airflow by widening the internal nasal passage

• Rapid recovery through a minimally invasive approach

• Addressing the root cause of nasal obstruction

5. Nasolabial angle correction

• Harmonizing the overall balance between the nose and lips

• Improvement in the profile line

1. Functional improvement

• The leftward-deviated septum was realigned to the midline

• Securing internal nasal airway space with turbinoplasty

• Smooth, comfortable breathing restored on both sides

• Substantial improvement in chronic nasal obstruction

2. Structural stability

• Sturdy septal reconstruction using autologous rib cartilage

• Fundamental reinforcement of nasal structures compromised by previous surgeries

• Promoting a stable, long-lasting surgical result

3. Aesthetic improvement

• Restoration of frontal symmetry by correcting the crooked nasal bones

• Creating a natural nasal profile line

• A refined profile line through nasolabial angle correction

4. Improvement of the nostrils and columella

• Well-balanced nostril shape on both sides

• Columella realigned along the facial midline

Revision rhinoplasty cases—especially when multiple prior surgeries have been performed—involve weakened tissue planes and existing scar tissue, necessitating an exceptionally meticulous approach.

In this scenario, the most critical element was reconstructing the septum. The septum serves as the central supporting pillar of the nose, and here it had been substantially weakened by previous operations. Attempting cosmetic changes without first addressing a compromised septum inevitably leads to structural issues resurfacing over time.

Therefore, our foremost priority was to solidly reconstruct the septum using autologous rib cartilage. Because autologous rib cartilage is harvested from the patient's own body, there is no risk of rejection, and it provides ample volume and structural rigidity, making it an ideal graft material for revision surgery.

Furthermore, because the leftward septal deviation caused substantial nasal obstruction, septoplasty was combined with inferior turbinoplasty. Radiofrequency submucosal resection of the inferior turbinates is an effective method that widens the internal nasal airway with minimal bleeding and a rapid recovery.

Lateral osteotomy was performed to straighten the crooked nasal bones, and nasolabial angle correction improved overall facial balance. Revision rhinoplasty is inherently more challenging than primary rhinoplasty, requiring delicate surgical precision. Nonetheless, through precise diagnosis, systematic planning, and the selection of graft materials tailored to the patient's tissue condition, satisfying outcomes can be achieved.

I will continue to do my best to provide fundamental, structurally sound solutions for patients troubled by outcomes of previous nasal surgeries. This has been Medical Director Dr. Peter C. Kang. Thank you.

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