Hello, this is Dr. Cha-Young Kang, Director of Nose Lab Clinic
Today, I’ll share the story of a patient who finally achieved her desired nasal appearance after a complex, sixth revision rhinoplasty.
1. Surgical History
Between 2009 and 2014, the patient underwent a total of five rhinoplasty surgeries, trying different materials and techniques, including septal cartilage, ear cartilage, donor rib cartilage, autologous rib cartilage, and silicone implants. Despite these attempts, she remained dissatisfied with the outcomes. Additionally, she received nasal filler injections eight years ago.
2. Pre-Surgical Analysis and Design Consultation
In our pre-surgical consultation, we analyzed her nose in detail and identified several issues:
Pre-Surgery Design Consultation: Frontal View, Right Side View, and Oblique Side View Photos
Upturned nasal tip
High starting point of the nasal bridge
Artificial-looking, arched “soft bridge” shape
Visible nostril asymmetry and scarring from aggressive philtrum and alar reduction
Noticeable columella scarring from multiple open rhinoplasty procedures
Pre-Surgery Design Consultation: Nostril View, Right Side View, and Oblique Side View Photos
3. Patient’s Goals
The patient expressed her hopes for:
A naturally refined yet elegant nose
A straight bridge with a subtle curve
Correction of the upturned tip
Improvement of nostril asymmetry
4. Surgical Plan
To address these complex concerns, we devised a comprehensive surgical approach:
Septal Extension Graft: To correct the upturned tip and precisely shape the nasal tip
Reuse of Existing Autologous Tissue: Incorporating available autologous rib, septal, and ear cartilage to minimize reliance on additional materials
Additional Rib Cartilage Harvesting: Using autologous rib cartilage as the primary material for a stable tip
Removal of Foreign Substances: Clearing out residual filler and silicone implants
Customized Silicone Implant: Reshaping and positioning a new silicone implant at a slightly lower starting point to achieve a more balanced bridge
Surgical Process
As anticipated, this procedure was highly challenging due to the damaged normal tissue and extensive scar tissue from prior surgeries. The septal cartilage was severely compromised, which we identified as the main cause of the nasal tip’s upturn and instability. To address this, we reconstructed the septum using autologous rib cartilage for stability.
This case emphasizes the importance of a careful, customized approach in revision rhinoplasty, especially in complex cases with significant surgical history. Factors such as the remaining tissue, patient goals, and facial proportions must all be considered to create an optimal surgical plan. Achieving a natural result requires tailoring the procedure to harmonize with each patient’s unique facial characteristics rather than merely following trends.
5. Immediate Post-Surgical Results
Immediately after surgery, the results showed a remarkable improvement:
Before Surgery (Left) / Immediately After Surgery (Right)
Before Surgery (Left) / Immediately After Surgery (Right)
Before Surgery (Left) / Immediately After Surgery (Right)
Before Surgery (Left) / Immediately After Surgery (Right)
Final Thoughts
This case highlights the need for specialized expertise and a tailored approach in revision rhinoplasty. Open rhinoplasty and multiple surgeries can leave scar tissue, often making additional open surgeries risky. For high-risk cases like this, closed approaches can be a safer alternative that still allows for complex adjustments.
If you’re considering revision rhinoplasty, especially for complex issues like upturned or asymmetrical noses, a thorough consultation with an experienced specialist is essential to find the best approach. Nose Lab Clinic is dedicated to delivering safe, satisfying outcomes through careful, individualized planning.
Thank you,Dr. Cha-Young Kang, Director of Nose Lab Clinic.
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