Why does the nose look crooked when the osteotomy site is over-resected? Nasal bone restoration and nasal tip reconstruction

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a revision rhinoplasty case in which a crooked nose and over-resected nasal bone were restored simultaneously, while the nasal tip was refined using autologous rib cartilage.

In this type of case, the patient had undergone dorsal hump reduction, osteotomy, and rhinoplasty using ear cartilage about 3 years ago. Over time, however, issues such as a crooked nose and a bulbous nasal tip developed, leading the patient to consider revision rhinoplasty.

When the patient came to NOSELAB for a consultation, the concerns were as follows:

• Correction of deviated nose

• Correction of the bulbous nasal tip

• Reduced nostril show on the front view

• Open to using a silicone implant if necessary

The patient was particularly concerned about the crooked appearance of the nose and the bulbous nasal tip.

After a thorough analysis of the patient's condition, the previous osteotomy site was found to be over-resected, requiring nasal bone restoration. A surgical plan was established to perform tip rhinoplasty and nasal bone restoration simultaneously.

1. Septal extension using autologous rib cartilage

• Harvesting autologous rib cartilage to reinforce tip support

• Extending the septum to elevate the nasal tip

• Refining the bulbous nasal tip for a sleeker contour

2. Restoration of the left nasal bone

• Restoring the over-resected left nasal bone region

• Correction of the deviated nasal bridge

• Achieving bilateral symmetry

3. Custom-carved silicone implant

• Silicone implant precisely carved to match the patient's nasal bone contours

• Carving the implant meticulously to naturally fit the restored nasal bone line

• Smoothly connecting the nasal bridge line

4. Correction of nasolabial angle

• Adjustment of the angle between the nose and the lips

• Minimizing nostril show from the front view

• Improvement of the profile silhouette

Front view changes:

• The nose that deviated to the left has been straightened

• The bulbous nasal tip has been refined into a sleek contour

• Nostril show has naturally decreased

Profile view changes:

• Smooth and natural nasal bridge line achieved

• A refined profile through nasolabial angle correction

• The nasal tip was appropriately elevated, improving overall balance

Changes in the nasal bone:

• The over-resected area has been naturally restored

• The silicone implant sits stably along the nasal bone contour

• Symmetric nasal bridge line

In revision rhinoplasty, restoring an over-resected nasal bone while simultaneously performing tip rhinoplasty is a highly complex procedure. This is because both issues must be addressed individually while still achieving overall harmony.

In this type of case, autologous rib cartilage was used to reinforce the structural support of the nasal tip, and the silicone implant was meticulously carved to fit the patient's nasal bone contour, creating a natural nasal bridge line. In particular, when restoring an over-resected area, one must carefully evaluate the condition of the remaining bone and surrounding tissues and approach the procedure with great caution.

Revision rhinoplasty requires more meticulous planning and technique than primary rhinoplasty because it must account for tissue alterations and scar tissue from previous surgeries. Accurately assessing the patient's current condition and selecting the most appropriate method accordingly is key to achieving a successful outcome.

I will continue to provide customized surgical care tailored to each patient. I hope this case helps those with similar concerns. This has been Dr. Peter C. Kang, Medical Director. Thank you.

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