5th Revision Rhinoplasty and Septal Reconstruction – Real Patient Case Using Autologous Rib Cartilage

noselab

3월 5일2분 분량

[Nose Lab Clinic]

Hello, this is Dr. Cha-Young Kang, Chief Surgeon at Nose Lab Clinic.

Today, I’m sharing a complex case of a patient who underwent multiple revision rhinoplasties. She came to our clinic for her 5th revision surgery, aiming to restore breathing function and improve columellar aesthetics through reconstruction.

Design Consultation: Frontal View, Left Side View, and Oblique Side View Photos

Design Consultation: Right Side View, Oblique Side View, and Nostril View Photos

1. Surgical History

10 years ago: Septoplasty + silicone implant + ear cartilage
8 years ago: Removal of protruding Medpor implant + revision surgery
8 years ago: Skin graft from postauricular (behind ear) area + Alloderm + ear cartilage + rib cartilage
5 years ago: Silicone + fat graft + autologous dermis + rib cartilage

2. Chief Complaints

Severe nasal obstruction (primarily mouth-breathing)
Columellar deformity (thickness, visibility)
Asymmetry and deviated nose

Nasal Endoscopy Photos

3. Patient’s Requests

Columellar improvement (adjust thickness and visibility)
Straight nasal bridge (I-line) formation
Adjust starting point (radix) height
Correct asymmetry and deviation

4. Surgical Procedure

Before (Left) / Immediately After (Right)

a. Functional Improvement

Septoplasty for deviated septum
Radiofrequency laser turbinoplasty (inferior turbinates)
Septal reconstruction using autologous rib cartilage

Before (Left) / Immediately After (Right)

b. Columellar Enhancement

Bilateral skin-dermis composite graft from behind the ear
Improved columellar thickness and visibility

Before (Left) / Immediately After (Right)

c. Aesthetic Correction

Formation of straight nasal bridge (I-line)
Adjustment of radix height
Correction of nasal asymmetry

Before (Left) / Immediately After (Right)

5. Surgical Results

a. Functional Outcome

Significant improvement in nasal breathing
Stabilized nasal septum after reconstruction
Overall improved structural stability

b. Columellar Appearance

Natural thickness achieved
Improved columellar show
Balanced and aesthetically pleasing result

c. Overall Nasal Appearance

Straightened nasal bridge (natural I-line)
Adjusted radix height creating harmony
Enhanced symmetry and overall balance

6. Expert Insights

This was a challenging case due to the complexity of multiple previous surgeries. The patient’s primary concerns were significant functional breathing difficulties and columellar deformity. Our approach involved careful use of autologous rib cartilage to rebuild and stabilize the severely compromised nasal septum. Additionally, composite skin-dermis grafts from behind the ear effectively addressed the columellar issues. The patient’s request for a natural, straight nasal bridge was successfully met, providing both functional relief and aesthetic improvement simultaneously.