Why a operated nose deviates and nostrils become asymmetric after physical trauma, and how septal reconstruction is performed

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a revision rhinoplasty case of a patient who visited our clinic concerned about a bulbous tip, a crooked nose, and nostril asymmetry.

About 4 years ago, the patient had rhinoplasty at another medical clinic using autologous rib cartilage and a silicone implant; over time, the nasal tip drooped and a dorsal hump developed, which was the initial concern. About 2 years ago, the patient underwent revision surgery at a different clinic using donor rib cartilage and a silicone implant. One month after that surgery, external trauma caused nasal deformity, and the patient only received immediate repositioning at the time. At the initial visit, the nasal tip appeared round and spread out on front view, and the columella was tilted to the left, accompanied by nostril asymmetry.

• Improvement of the round, spread-out appearance of the nasal tip on front view

• Correction of the deviated nasal bridge

• Preference for a natural line with gentle curves

• An overall slimmer nasal profile

• A softer curved impression rather than a strictly straight look

1. Septal reconstruction (using autologous rib cartilage)

• During surgery, the anterior portion of the septal cartilage was confirmed to be torn and deformed

• Presumed to be damage sustained from the external trauma about 2 years ago

• Firm septal reconstruction performed using autologous rib cartilage

2. Columellar repositioning and improvement of nostril asymmetry

• The left-tilted columella was realigned along the central axis

• Restoration of balance between both nostril shapes

3. Septoplasty and rhinitis surgery

• Examination for nasal obstruction revealed both a deviated septum and rhinitis

• Septoplasty and turbinate surgery (rhinitis surgery) were performed simultaneously to relieve functional discomfort

4. Reshaping the nasal bridge line

• Removal of existing silicone implant

• The implant was recarved to fit the contours of the patient's nasal bone before insertion

• Establishment of a natural, well-defined bridge line

5. Nasolabial angle correction

• Natural adjustment of the angle between the nose and upper lip

• Improvement in the balance of the profile line

Front view changes

• The round, spread-out nasal tip was naturally refined

• Narrowing of the bridge width, creating an overall slimmer line

• Correction of the crooked appearance, restoring left-right symmetry

Profile view changes

• A stable nasal tip supported without drooping

• A soft bridge line with a gentle curve

• A more refined profile line through nasolabial angle correction

Changes in nostril shape

• Restoration of the left-tilted columella to the central axis

• Natural improvement of nostril asymmetry

In complex revision rhinoplasty, one must account not only for traces of past surgeries but also for deformities caused by external trauma. When the anterior portion of the septal cartilage is damaged and the central axis of the nose is compromised, as in this patient's case, stable outcomes cannot be achieved through simple cosmetic adjustments alone.

For this presentation, the key was rebuilding a firm central axis of the nose through septal reconstruction using autologous rib cartilage. The tilted columella and nostril asymmetry were corrected simultaneously, and functional surgery for the accompanied deviated septum and rhinitis was also performed, resolving both aesthetic and functional issues at once.

Rather than reusing the existing silicone implant as it was, it was sculpted by hand to fit the contour of the patient's nasal bone to ensure a natural fit. Securing a stable structural foundation alongside septal reconstruction leads to lasting satisfaction.

Moving forward, I will continue to carefully reflect each patient's structural characteristics and aesthetic needs to create natural results planned with safety in mind.

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

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