Why nostril asymmetry worsens with repeated revisions, and how to correct the columella

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who visited our clinic because, despite multiple previous nasal surgeries, the columella gradually drooped and deviated, causing progressively worse nostril asymmetry.

This patient had undergone a total of 6 prior nasal surgeries.

• About 12 years ago: First rhinoplasty using septal cartilage, ear cartilage, and a silicone implant

• About 6 years ago: Revision rhinoplasty using autologous rib cartilage, a silicone implant, and ear cartilage (the nose became crooked immediately after surgery)

• Followed by 1 alar rim elevation surgery

• About 4 years ago: Implant-free revision rhinoplasty using autologous rib cartilage, along with functional surgery

• About 3 years ago: Additional revision rhinoplasty using banked autologous rib cartilage

• About 1 year and 6 months ago: Nostril elongation surgery using ear cartilage

The patient's greatest concern was improving the nostril asymmetry. The primary complaint was that as the columella gradually descended and tilted to one side, the asymmetry became increasingly severe. While satisfied with the overall shape of the nose, the patient was bothered by the cartilage showing through and feeling palpable at the columellar tip, as well as the noticeable difference between the left and right nostrils.

Surgery was performed through a closed approach as follows.

1. Reinforcement of the nasal bridge and nasal tip using autologous rib cartilage

Using autologous rib cartilage, the nasal bridge and nasal tip were naturally elevated to secure a stable supporting structure.

2. Lateral osteotomy for crooked nose correction

To correct the deviation of the nasal bridge, a lateral osteotomy was performed to realign the nasal bones.

3. Columellar correction to address nostril asymmetry

In many cases, nostril asymmetry occurs because the columella tilts to one side. The direction of the columella was realigned to restore balance between the left and right sides.

Front view changes:

• The deviated nasal bridge was straightened

• Left-right nostril symmetry was significantly improved

Profile view changes:

• A natural and stable nasal bridge line was achieved

• Columellar drooping and deviation were improved

Nostril view changes:

• The columella that tilted to one side was straightened

• Left-right balance of nostril size was improved

When a patient has undergone multiple revisions, the internal tissue condition is complex, necessitating a more meticulous approach. In particular, although nostril asymmetry may appear simply as a difference in nostril size, it actually involves a combination of the columella's direction and the positioning of the nasal tip cartilage.

In this surgery, the focus was on fundamentally correcting the asymmetry caused by the columella tilting to one side. By reinforcing the supporting framework with autologous rib cartilage, the structure was rebuilt to maintain stable results over time.

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

#closedrhinoplasty #closedrevisionrhinoplasty #crookednosecorrection #nostrilasymmetry #autologousribcartilage #revisionrhinoplasty #columellacorrection #lateralosteotomy