Why contracture remains in multiply operated noses: Reconstructing the columella and support framework

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce a reconstruction case of a patient who was experiencing difficulties with both the shape and function of the nose due to contracture deformity following multiple nasal surgeries.

This patient was an individual who had undergone a total of 6 nasal surgeries.

• About 17 years ago: Alar reduction

• About 6 years ago: Rhinoplasty using an implant and autologous rib cartilage -> Implant removed due to inflammation

• 6 months later: Revision rhinoplasty with an implant and autologous rib cartilage -> Implant removed again after splint removal due to redness

• 6 months later: Reconstruction of the nasal bridge and nasal tip using only autologous rib cartilage -> Deformity occurred where the nasal tip became short and pointed

• About 3 years ago: Additional revision after newly harvesting autologous rib cartilage

Through repeated surgeries, wound healing in the columellar area was compromised, and generalized contracture deformity had progressed.

• Desire to lower the radix (starting point of the nasal bridge)

• Improve the retracted columella so that it becomes visible

• Correct the pinched-looking areas

• Correction of crooked nose

• Improve nasal obstruction alternating between both sides

This surgery focused on fundamentally reconstructing the internal nasal structures damaged by contracture.

1. Septal reconstruction using autologous rib cartilage

The septal cartilage, of which almost none remained from previous surgeries, was newly reconstructed with autologous rib cartilage to secure the core support framework of the nose.

2. Reconstruction of the left lower lateral cartilage

The almost completely lost left lower lateral cartilage was restored with autologous rib cartilage, regaining the shape and support of the nasal tip.

3. Correction of pinched nostrils and columellar reconstruction

To lower the retracted columella, free flap grafting (skin grafting) using retroauricular skin was performed on both sides of the columella. Perichondrium grafting was also performed concurrently to increase the graft survival rate of the transplanted skin.

4. Functional surgery for nasal obstruction relief

Correction of the deviated septum and rhinitis surgery were performed simultaneously to improve breathing function, and a bacterial culture test was also performed to check for any residual inflammation that might remain inside the nose.

Front view changes:

• Symmetry secured for the previously deviated nasal bridge

• Previously irregular nasal bridge line smoothly refined

Profile view changes:

• Naturally lowered the high radix

• Retracted columella brought down to an appropriate position

• Overall natural nasal line achieved

Nostril view changes:

• Improvement in the pinched nostril appearance

• Restoration of columellar volume through skin grafting

When contracture has progressed through multiple surgeries, most of the internal nasal support structures are lost, necessitating fundamental reconstruction rather than simple correction. In cases like this, where almost no septal cartilage and lower lateral cartilage remained, creating new structural frameworks using autologous rib cartilage was the key.

Particularly when columellar skin is deficient due to repeated surgeries, free flap grafting using retroauricular skin can be an effective solution. Increasing the skin graft survival rate through perichondrium grafting is also an important point.

Without overlooking the functional aspects of the nose, correction of the deviated septum and rhinitis surgery were performed together, aiming for both aesthetic refinement and improved respiratory function at the same time.

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

#revisionrhinoplasty #contractednosecorrection #autologousribcartilage #columellareconstruction #skingraft #septalreconstruction #lowerlateralcartilagereconstruction #nasalobstructionimprovement #deviatedseptum #menrhinoplasty #crookednosecorrection #closedrhinoplasty #closedrevisionrhinoplasty