Why nasal bone deviation and dorsal humps remain after rhinoplasty: lateral osteotomy and autologous rib cartilage correction methods

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a revision rhinoplasty case of a patient who visited our clinic with persistent concerns about a deviated nasal bone, a dorsal hump shape, and nasal obstruction even after a previous rhinoplasty.

The patient had a history of prior nasal procedures and surgery.

• Approximately 10 years ago: nasal filler procedure

• Approximately 5 years ago: rhinoplasty with a silicone implant (including osteotomy, septal surgery, and rhinitis surgery)

Although some correction was achieved through the previous surgery, the deviation of the nasal bones and the dorsal hump shape were not sufficiently improved, and nasal obstruction symptoms still remained.

The patient's specific requests were as follows:

• Natural nasal line

• Adjusting the radix (naturally lowering the high radix)

• Improving the dorsal hump shape

• Correction of deviated nasal bones

• Correcting the appearance of an overly long nose

• Improvement of nasal obstruction

In particular, the patient prioritized natural-looking results above all else and wanted meticulous correction of the areas that had not been adequately resolved in the previous surgery.

1. Removal of existing implant and structural reconstruction

• Removal of silicone implant placed during previous surgery

• Clearing residual filler

• Establishing a surgical plan after reassessing the altered tissue

2. Lateral osteotomy

• Correction of deviated nasal bones

• Narrowing the wide nasal bridge width

• Improving the dorsal hump shape

• Restoring nasal bone symmetry

3. Nasal tip plasty using autologous rib cartilage

• Projecting the nasal tip to correct the appearance of an overly long nose

• Reinforcement of the nasal tip support framework using autologous rib cartilage

• Creating a natural yet refined tip line

4. Nasal bridge augmentation using a silicone implant

• Silicone implant precisely carved to fit the nasal bone

• Implant placed solely along the nasal dorsum to maintain a natural shape

• Connecting from the forehead line to the nasal tip in a natural straight bridge line

5. Septoplasty and inferior turbinate reduction

• Internal nasal structures realigned by correcting the deviated septum

• Rhinitis symptoms improved by reducing hypertrophied inferior turbinates

• Restoration of breathing function

Front view changes

• The deviated nasal bones were straightened

• The wide nasal bridge width was naturally reduced

• Overall balanced nasal shape

Profile view changes

• The dorsal hump shape disappeared, creating a smooth bridge line

• The nose, which previously appeared long, was corrected to proper proportions by elevating and projecting the tip

• Natural straight bridge line created from forehead to nasal tip

• The radix was naturally adjusted, creating a refined profile silhouette

Changes on the oblique view

• A smooth, natural bridge line even from the oblique 45-degree angle

• A refined impression achieved by properly projecting the nasal tip

• Nasal shape in harmony with the overall face

Changes in nostril shape

• Nostril shape naturally changed as the nasal tip was projected

• Balanced, symmetric nostril shape

• An overall natural nasal base line

In this type of case, the patient decides on revision rhinoplasty because the nasal bone deviation, dorsal hump shape, and nasal obstruction were not adequately improved after a previous procedure. Because revision rhinoplasty requires addressing scar tissue and altered structures from previous surgeries, it demands more precise planning and a higher level of surgical skill than primary rhinoplasty.

The most essential part of this surgery was the lateral osteotomy. Because the nasal bones were deviated and wide, accompanied by a dorsal hump, osteotomy was used to realign the position of the nasal bones and narrow their width, creating a straight, smooth bridge line.

Additionally, the patient wanted to correct the impression of an overly long nose; by using autologous rib cartilage to elevate and project the nasal tip, the perceived length of the nose was visually reduced, creating a refined tip line. For the nasal bridge, a silicone implant was carved precisely to match the patient's nasal bone anatomy and placed only along the bridge, creating a natural straight bridge line flowing smoothly from the forehead down to the tip.

To resolve the nasal obstruction simultaneously, septoplasty and inferior turbinate reduction were performed together. During revision surgery, the difficulty of functional procedures increases because the altered internal structures from the prior surgery must also be accounted for. In this case, meticulous correction of the septum and inferior turbinates also improved respiratory function.

For those considering revision rhinoplasty, it is critical to develop a surgical plan through thorough consultation with a specialist who can accurately assess your surgical history and current nasal condition. NOSELAB strives to address each patient's concerns with care, even in these complex revision cases, to achieve the intended result.

This was Dr. Peter C. Kang. Thank you.

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