Why noses deviate and bulbous tips persist after double jaw surgery, and how rib cartilage septal reconstruction is performed

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce a revision rhinoplasty case of a patient who presented with a crooked nose, a blunt bulbous nose, nostril asymmetry, and severe bilateral nasal obstruction despite having undergone double jaw surgery and two prior rhinoplasties. It was a complex and demanding revision case requiring improvements in both function and aesthetics.

• 5 to 6 years ago: Double jaw surgery

• January 2023: First rhinoplasty (silicone implant + autologous rib cartilage + rhinitis surgery)

• July 2023: Custom bridge implant replacement

• Correction of the nasal bridge deviated to the left and the tilted columella

• Improvement of the blunt, wide bulbous tip

• Correction of nostril asymmetry

• Relief of severe bilateral nasal obstruction

• Achieving a natural and well-balanced nasal line

1. Septal reconstruction using autologous rib cartilage

• Restoration of the septal cartilage damaged by double jaw surgery

• Correction of the columella tilted to the left

• Securing structural support for the nasal tip

2. Structural correction of the bulbous nose

• Adjusting skin thickness by removing part of the subcutaneous tissue and scar tissue

• Repositioning of lower lateral cartilage

• Narrowing the spread nasal tip through cartilage suturing

3. Functional nasal surgery to relieve nasal obstruction

• Septoplasty performed

• Rhinitis surgery performed simultaneously

• Resolution of bilateral nasal obstruction

4. Nasal bridge implant replacement

• Removal of the existing custom implant that had shifted and curved to the left

• Insertion of a new silicone implant precisely carved to fit the nasal bone

5. Lateral nasal bone osteotomy

• Correction of nasal bone asymmetry

• Restoration of left-right symmetry

Front view changes:

• The previously crooked nasal bridge is neatly aligned

• The blunt and wide nasal tip appears well-defined

• Achieving bilateral symmetry

Profile view changes:

• Securing stable support for the nasal tip

• A natural straight bridge line

• Improvement in the distorted dorsal line caused by the deviated implant

Nostril view changes:

• Correction of the columella that was tilted to the left

• Improvement of nostril asymmetry

• A balanced nostril shape

This was a complex revision case combined with a history of two prior rhinoplasties and double jaw surgery. During the double jaw surgery, the septal cartilage had been severely damaged, and even the anterior nasal spine at the nasal floor was reshaped asymmetrically, making septal reconstruction particularly challenging.

In such complex revision cases, septal reconstruction using autologous rib cartilage is the most stable option. Because it uses the patient's own cartilage, rejection reactions are low, and it provides sufficient strength and length to secure not only tip support but also a renewed foundation for the overall nasal structure.

In bulbous tip correction, one must address skin thickness alongside cartilage work. Only after properly trimming subcutaneous tissue and scar tissue, while simultaneously performing lower lateral cartilage repositioning and cartilage suturing, can a defined yet natural nasal tip line be achieved.

Additionally, the patient had a bleeding tendency, which resulted in a relatively high amount of bleeding during surgery. In such cases, meticulous hemostasis and careful tissue protection are required, and the procedure must proceed with safety as the top priority, even if the operative time is somewhat prolonged.

Revision rhinoplasty requires a customized surgical plan that comprehensively takes into account the patient's tissue condition, previous surgical history, and functional problems. NOSELAB will always do its best to provide safe and satisfying results, even in challenging revision cases.

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

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