Why the nose looks short and the columella retracts after revision rhinoplasty, and how to reconstruct the septum

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce the case of a patient who visited our clinic because concerns regarding the profile line and bulbous tip remained unresolved despite multiple prior nose surgeries.

The patient had a history of undergoing 3 previous nose surgeries.

In the first surgery, the patient underwent rhinoplasty using an L-shaped silicone implant and ear cartilage along with alar reduction. This was followed by revision rhinoplasty using a silicone implant and mesh. Finally, the patient underwent another revision using donor rib cartilage and a silicone implant, but was unable to achieve a satisfactory result.

The patient's primary concerns were as follows:

• Improving the profile line and correcting the bulbous tip

• Correcting the retracted columella and short-looking nose

• Correcting an excessively high radix

• A refined, feminine straight bridge line

The patient had previously been told that further correction would be difficult due to a lack of available skin envelope, making this a case that required a particularly delicate approach.

Upon diagnosis, excessive harvest in previous surgeries left almost no remaining septal cartilage. Accordingly, the following surgical plan was established.

1. Septal reconstruction using autologous rib cartilage

• Reinforcing deficient septal cartilage with autologous rib cartilage

• Firmly reconstructing the nasal tip support framework

2. Correction of the nasal radix starting point

• Naturally lowering the excessively high radix

• Creating a nasal line in harmony with the face

3. Nasolabial angle correction

• Refining the nasal tip shape

• Improving the nasal tip angle seen from the profile view

Front view changes:

• Natural correction of the blunt, bulbous tip

• Overall balanced nasal shape

Profile view changes

• The radix is naturally lowered

• Feminine straight bridge line achieved

• A refined nasal tip silhouette achieved through nasolabial angle correction

Changes in nostril shape

• Improvement of the retracted columella

• Securing adequate nasal length for a previously short-looking nose

In patients who have undergone multiple surgeries, it is common that insufficient septal cartilage remains. In such circumstances, reconstructing the deficient support structure using autologous rib cartilage is important for a stable result.

In this type of case, by firmly reconstructing the weakened septum using autologous rib cartilage while concurrently adjusting the radix and nasolabial angle, we were able to create the refined nasal line desired by the patient. Especially in revision rhinoplasty, accurately assessing the condition of existing tissues and selecting the appropriate materials and surgical methods are central to achieving a successful outcome.

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

#closedrhinoplasty #closedrevisionrhinoplasty #bulboustipcorrection #autologousribcartilage #revisionrhinoplasty #shortnosecorrection #nasolabialanglecorrection #septalreconstruction