Why nasal obstruction persists after multiple surgeries: How to reconstruct the septum and nasal valve

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who visited our clinic suffering from severe nasal obstruction after three prior rhinoplasties. For this revision, improving nasal breathing was the most important goal.

• Approximately 2 to 3 years ago: Tip plasty using ear cartilage and dorsal hump reduction (at another clinic) → Nostril appearance did not improve

• Approximately 2 years ago: Revision rhinoplasty using ear cartilage (at another clinic) → Developed a crooked nose; nostril appearance did not improve

• Approximately 8 months ago: Revision rhinoplasty using autologous rib cartilage and ear cartilage (at another clinic)

• Difficulty breathing was the most distressing concern

• Relieving nasal obstruction was the highest priority

1. Septal reconstruction

• From previous surgeries, the septum had collapsed to the right and the nasal roof had caved in, causing marked stenosis of the internal nasal valve

• Because the septum was in very poor condition, it was reconstructed using autologous rib cartilage

2. Restoration of previous osteotomy

• The nasal cavity space was narrowed due to overly aggressive lateral osteotomy performed during previous cosmetic surgery

• Internal nasal volume was restored through osteotomy reversal surgery

• Because a significant portion of the central nasal bone had been rasped away, restoring the bone caused a depression in the mid-dorsum

• The depressed mid-dorsal area was corrected using autologous rib cartilage

• A slight overcorrection of the nasal bone height was performed, anticipating that it would gradually settle over time

3. Tip skin reinforcement and alar cartilage reconstruction

• Because the nasal tip skin was extremely thin, it was reinforced using dermis and costal perichondrium

• With almost no native alar cartilage remaining, the lower lateral cartilage was reconstructed using autologous rib cartilage

4. Inferior turbinate surgery

• Potential empty nose syndrome was noted, resulting from excessive inferior turbinate reduction during previous rhinitis surgery

• Severe outfracture of the inferior turbinate had occurred, and the anterior part of the inferior turbinate had adhered to the lateral nasal wall

• Airway space was restored by infracturing the inferior turbinate and releasing the adhesions

• Anti-adhesion techniques were also applied to prevent recurrence

5. Nasolabial angle correction

• The nasolabial angle between the nose and upper lip was naturally adjusted

Functional improvement:

• Internal nasal structures normalized through septal reconstruction

• Breathing airway secured through internal nasal valve reconstruction

• Internal nasal volume restored through osteotomy reversal

• Right-sided nasal obstruction improved through inferior turbinate infracture and adhesiolysis

Cosmetic improvements:

• Depressed mid-dorsal area corrected (it may appear slightly high initially, but will look more natural over time)

• Tip skin reinforced to support a stable tip shape

• A refined profile line through nasolabial angle correction

Structural stability:

• Long-term structural stability supported through septal reconstruction with autologous rib cartilage

• Tip support framework restored through alar cartilage reconstruction

This was a complex case where the internal structures of the nose were substantially compromised after three prior surgeries. The nasal obstruction that troubled the patient most was not caused by a single issue, but by multiple contributing factors.

The internal nasal valve had narrowed from the septal collapse, internal nasal space had decreased due to overly aggressive lateral osteotomy, and complications had arisen from excessive inferior turbinate resection during prior rhinitis surgery—all coexisting simultaneously.

To address these combined issues comprehensively, we performed septal reconstruction, internal nasal valve reconstruction, right alar cartilage reconstruction, and inferior turbinate infracture with adhesiolysis. Autologous rib cartilage was chosen for every reconstruction step because it offers the most reliable stability when internal tissues have already been compromised by multiple surgeries.

I hope this case is helpful to those with similar concerns. This has been Dr. Peter C. Kang, Medical Director. Thank you.

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