Why internal nasal structures collapse after multiple rhinoplasties and total reconstruction with rib cartilage

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a revision rhinoplasty case of a patient whose internal nasal structures were severely damaged from multiple previous nose surgeries. In cases like this, abnormal findings around the implant on the preoperative CT scan required an even more meticulous approach.

The patient had undergone four prior nose surgeries over the course of about 10 years.

• About 10 years ago: First rhinoplasty using ear cartilage and a silicone implant

• About 7 years ago: Revision rhinoplasty using ear cartilage and a silicone implant

• About 5 years ago: Revision rhinoplasty using donor rib cartilage and a silicone implant

• About 1.5 years ago: autologous rib cartilage, silicone implant, and alar base elevation

Due to multiple surgeries, damage to the normal internal cartilage framework was suspected.

When the patient visited our clinic for consultation, the requests were as follows:

• Correction of deviated nose

• Desired an increase in overall nasal height

• Desired lowering the radix (starting point)

• Improvement of nostril asymmetry

• Desired a nasal tip that is not sharp or pointy

On the preoperative CT scan taken at our clinic, fluid retention suspicious for inflammation was observed around the implant. It was necessary to determine intraoperatively whether this was simple foreign material or inflammatory fluid.

Surgical findings and procedure

During the actual surgery, serous fluid was identified, and bacterial culture testing was ordered. Fortunately, it was not purulent discharge, so it was diagnosed as a chronic foreign body reaction. After antibiotic irrigation and complete capsule removal, reconstruction proceeded using autologous rib cartilage.

1. Foreign material removal and antibiotic irrigation

• Complete removal of foreign material surrounding the implant

• Capsule removal caused by chronic foreign body reaction

• Antibiotic irrigation to prevent infection

2. Septal reconstruction using autologous rib cartilage

• Confirmed that almost no septal cartilage remained, as anticipated

• Complete reconstruction of the septum using autologous rib cartilage

• Secured a stable structural foundation for nasal tip support

3. Lower lateral cartilage reconstruction using autologous rib cartilage

• Almost no lower lateral cartilage remained due to multiple surgeries

• Complete reconstruction of the lower lateral cartilages using autologous rib cartilage

• Established a structural foundation to shape the nasal tip

4. Nasal bridge reconstruction

• Identified erosion of part of the nasal bone after removing the foreign material

• The height of the nasal bridge had become significantly diminished

• Secured bridge height within a safe margin, considering the compromised condition of the tissues

• Reconstructed into a safe and aesthetically pleasing structure

5. Correction of nostril asymmetry via skin graft

• The right nostril had become narrowed and smaller

• Performed a skin graft inside the nostril

• Slightly enlarged the nostril size to correct asymmetry as much as possible

Front view changes:

• The crooked nose was straightened

• Improved nostril asymmetry

• Overall stable and natural contour

Profile view changes:

• Nasal bridge height secured within a safe margin

• Formation of a natural bridge line

• A soft tip shape that is not overly sharp

Structural changes:

• Secured a stable framework through complete reconstruction of the septum and lower lateral cartilages

• Maintains long-term structural stability

• Established a healthy tissue foundation

In patients who have undergone multiple rhinoplasties, the normal anatomical structures—the septal cartilage and lower lateral cartilages—are often damaged with little to none remaining. In this case, as expected, barely any septal or lower lateral cartilage remained, so both were completely reconstructed using autologous rib cartilage.

Particularly in this scenario, because abnormal findings were observed around the implant on CT, identifying the exact cause during surgery was essential. Serous fluid was noted and sent for bacterial culture. Diagnosing it as a chronic foreign body reaction rather than purulent infection allowed us to safely proceed with surgery following thorough antibiotic irrigation and complete capsule removal.

Furthermore, because part of the nasal bone was eroded following removal of the foreign material, the bridge height was markedly reduced. However, because the patient's native tissues were severely damaged and weakened, we did not aggressively raise the bridge. We established a safe, aesthetically sound structural framework; if additional height is desired, it can be slightly increased after 6 months once the surgical result has fully stabilized.

In revision rhinoplasty, it is important to accurately assess the current condition of the patient's tissues and pursue the intended result while prioritizing safety. Rather than an overly aggressive procedure, a stepwise approach can lead to better long-term results.

I will continue to prioritize patient safety and dedicate myself to achieving the intended results. I hope this serves as helpful information for those facing similar concerns. This has been Dr. Peter C. Kang, Medical Director. Thank you.

#closedrhinoplasty #closedrevisionrhinoplasty #autologousribrhinoplasty #septalreconstruction #alarreconstruction #foreignbodyremoval #revisionrhinoplastyspecialist #multiplerevisionrhinoplasties #nostrilasymmetry