Why a septum collapsing to one side causes a crooked nose and blocked breathing, and how to reconstruct it with autologous rib cartilage

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who visited our clinic seeking help for both functional and aesthetic nasal concerns caused by a long, drooping tip, a crooked nasal bridge, and a severely collapsed septum.

• 21 years ago: First rhinoplasty

• 4 years ago: Second revision rhinoplasty

• Lowering the radix for a natural look

• Improving the long-appearing nose

• Correction of crooked nose

• Improvement in irregular nasal bridge

• A natural straight bridge line

• Feminine bridge line

• An overall softer image

1. Septal reconstruction using autologous rib cartilage

Because the septum was completely collapsed to the right, the columella was tilted obliquely, resulting in nostril asymmetry and a drooping tip.

• Straightening the septum back into position using autologous rib cartilage

• Completely reconstructing the collapsed support framework

• Correcting the drooping tip by reinforcing tip support

2. Right alar reconstruction

The right ala was depressed, causing significant asymmetry.

• Structural reinforcement with cartilage grafting

• Restoring volume to the depressed ala

• Achieving bilateral symmetry

3. Mucosal defect reconstruction

A mucosal defect was identified during surgery.

• Reconstruction of the mucosal defect using a perichondrium graft

• Improvement of internal nasal cavity function

4. Re-carving the silicone implant

Because the existing silicone implant did not fit the shape of the nasal bone, the right nasal dorsum appeared depressed.

• Removal of existing silicone implant

• Precise re-carving to match the shape of the patient's nasal bone

• Forming a natural dorsal line with the re-carved silicone implant

5. Nasolabial angle correction

• Improvement of the nasolabial angle alongside the drooping tip

• Improvement of the profile silhouette

1. Frontal changes

• The crooked nasal bridge was straightened

• Asymmetrical nostrils achieved better balance

• The tilted columella was corrected straight

• An overall softer and more feminine impression

2. Profile changes

• The drooping tip was naturally elevated

• The long-looking nose was refined to more balanced proportions

• Creation of a natural straight bridge line

• A refined profile created by improving the nasolabial angle

3. Nostril changes

• The tilted columella was corrected straight

• Nostril asymmetry was significantly improved

• The drooping tip was appropriately elevated

4. Endoscopic comparison (internal nasal cavity changes)

• The septum, which was completely collapsed to the right, was straightened to the midline

• Significant expansion of the right nasal cavity airway space - marked improvement in breathing function

• Clean reconstruction of the mucosal defect area with a perichondrium graft

• Internal nasal structures stably restored through septal reconstruction

This case was not a simple aesthetic revision rhinoplasty, but a complex procedure completely reconstructing a severely collapsed septal framework.

When a septum completely collapses to one side, it leads not only to aesthetic concerns but also to functional problems such as reduced breathing capacity, aggravated rhinitis, and snoring. In this case, because the right nasal airway was nearly obstructed, a full septal reconstruction using autologous rib cartilage was essential.

In particular, comparing the before and after endoscopic photos clearly demonstrates how significantly the right nasal cavity space has expanded. This translates directly to a substantial improvement in breathing function.

Additionally, the mucosal defect resulting from previous surgeries was reconstructed with a perichondrium graft, and the silicone implant that did not fit the nasal bone was precisely re-carved, resolving the depression on the right bridge.

When revision rhinoplasty—especially septal reconstruction—is required, structural stability and functional improvement must be addressed together. True surgical success is achieved only when the nose's essential role of breathing is restored alongside aesthetic balance.

I will continue to provide customized care tailored to each patient's condition to achieve the intended results. I hope this case provides helpful insight to those with similar concerns. This has been Medical Director Dr. Peter C. Kang. Thank you.

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