Hello, this is Dr. Cha-Young Kang, head surgeon at Nose Lab Clinic.
Today, I’d like to share a rhinoplasty case involving a patient who had been struggling with a contracted and upturned nose following multiple surgeries.
This patient faced significant challenges after several rhinoplasties, including complications from inflammation that led to nose contraction and an upturned nasal tip.
Despite the complexity of this revision case, we achieved a remarkable transformation using customized rhinoplasty with autologous rib cartilage.
1. Patient History and Requirements
Patient’s Surgical History:
2012: L-shaped silicone implant insertion
2019: Silicone + autologous rib cartilage + alar base reduction + philtrum reduction
2023: Silicone + ear cartilage + alar lowering (inflammation occurred immediately after splint removal, followed by antibiotic treatment)
2023 (5 months later): Silicone removal
Upon visiting Nose Lab Clinic: Six sessions of stem cell therapy
Patient's Requests:
Correction of the upturned nose
Correction of nostril asymmetry
Correction of the depressed nasal tip
Creation of a subtle dorsal hump (aquiline nose)
Adjustment of the nasolabial angle
2. Pre-Surgery Design Consultation
Detailed Analysis of the Patient's Pre-Surgery Condition:
Pre-Surgery Design Consultation: Frontal, Left Oblique, and Left Profile Views
Frontal View:
Visible Nostrils and Asymmetry
Wide and Flat Nasal Bridge
Depressed Scar on Nasal Tip
Left Oblique View:
Blunt and Upturned Nasal Tip
Flat Nasal Bridge with Lack of Definition
Left Profile View:
Blunt and Depressed Nasal Tip
Excessive Nostril Show
Inappropriate Nasolabial Angle
Pre-Surgery Design Consultation: Right Oblique, Right Profile, and Nostril Views
Nostrils:
Narrowed Nostrils
Wide Columella
Blunt Nasal Tip
Pronounced Nostril Asymmetry
3. Surgical Plan
Taking into account the patient's condition and requests, the following surgical plan was established:
a) Septal Extension with Autologous Rib Cartilage
b) Septal Reconstruction
c) Correction of Nostril Asymmetry by Shifting the Septum to the Left
d) Creation of a Dorsal Hump Using Autologous Rib Cartilage
e) Reconstruction of Alar Cartilage Using Autologous Rib Cartilage
f) Adjustment of the Nasolabial Angle
4. Surgical Procedure
The surgery was performed using a closed (endonasal) approach, and the following steps were taken:
a) Harvesting Autologous Rib Cartilage:
Rib cartilage was harvested from the patient to secure a sufficient amount of material for the nasal reconstruction.
b) Septal Extension and Reconstruction:
The septum was extended and reconstructed using the autologous rib cartilage.
The septum was extended and reconstructed using the autologous rib cartilage.
c) Correction of Nostril Asymmetry:
The septum was shifted to the left, which helped improve the asymmetry of the nostrils, creating a more balanced appearance.
d) Creation of a Dorsal Hump:
The rib cartilage was precisely sculpted to form a natural-looking dorsal hump, achieving the patient's request for a slightly aquiline nose.
e) Reconstruction of Alar Cartilage:
The alar cartilage was rebuilt using autologous rib cartilage.
This provided better support and definition to the nasal tip, improving its overall shape and durability.
f) Adjustment of the Nasolabial Angle:
The position of the nasal tip and septum was adjusted to create an appropriate nasolabial angle, enhancing the harmony of the patient’s profile.
5. Before and After Photo Comparison
Upon reviewing the post-surgery photos, the following improvements can be observed:
Frontal view before surgery (left) after surgery (right)
Frontal View:
The upturned nose has been corrected, significantly reducing the exposure of the nostrils.
The nasal bridge appears more refined and structured, adding depth and definition to the face.
The asymmetry of the nostrils has been noticeably improved, creating a more balanced look.
45-degree angle view before surgery (left) after surgery (right)
Oblique View:
A natural dorsal hump has been created, giving the nasal bridge a more elegant and defined contour.
The bluntness and upturned appearance of the nasal tip have been corrected, resulting in a more refined shape.
Reduced nostril exposure provides a more natural and aesthetically pleasing appearance.
Side profile view before surgery (left) after surgery (right)
Profile View:
The blunt and pressed-down appearance of the nasal tip has been improved, with better projection and definition.
A smooth and natural dorsal hump is now visible along the nasal bridge, enhancing the profile.
The nasolabial angle has been corrected, improving the appearance of a previously protruded upper lip.
The visibility of the nostrils has been significantly reduced, contributing to a more harmonious profile.
Nostrils before surgery (left) after surgery (right)
Nostril View:
The previously narrow nostrils have been widened to an appropriate size, improving function and appearance.
The wide columella has been naturally narrowed, contributing to a more refined and proportionate nasal base.
The once blunt nasal tip has been reshaped, resulting in a more natural and elegant appearance.
The asymmetry between the nostrils has been substantially corrected, achieving a more symmetrical and balanced look.
6. Post-Surgery Photo Collection
Photos taken immediately after surgery, frontal view, 45-angle view, and side profile.
Photo of the nostrils
7. Final Evaluation
This case was a complex revision surgery that required addressing issues from multiple previous surgeries and inflammation-induced contraction. Despite these challenges, we achieved remarkable results through a meticulously planned, customized rhinoplasty using autologous rib cartilage.
Key highlights from this surgery include:
Use of Autologous Rib Cartilage: By utilizing a sufficient amount of the patient's own rib cartilage, we were able to achieve a stable and natural outcome.
Septal Reconstruction and Extension: This was crucial in correcting the upturned nose and resolving structural instability, providing the necessary support for long-term results.
Precise Dorsal Hump Creation: We carefully sculpted a natural-looking dorsal hump, fulfilling the patient’s request for a subtle yet defined nasal bridge contour.
Correction of Nostril Asymmetry: By adjusting the position of the septum, we successfully resolved the long-standing issue of nostril asymmetry.
Nasolabial Angle Adjustment: The alignment of the nose and lips was improved, enhancing overall facial harmony and balance.
Through this surgery, we were able to meet all of the patient’s requirements. The upturned nose was corrected, nostril asymmetry was resolved, and the depressed nasal tip was naturally restored. Additionally, the requested dorsal hump was achieved, and the nasolabial angle was refined, resulting in a balanced and harmonious nasal appearance.
8. Closing Remarks
I hope this case provides hope to those struggling with issues like contracted or upturned noses. Reconstructive surgery for contraction due to inflammation often presents significant challenges, and the expected outcomes can differ greatly from the actual surgical process. At Nose Lab Clinic, we take these complex revision cases seriously by incorporating stem cell therapy before surgery to enhance the chances of a positive outcome.
I also want to emphasize the importance of using autologous tissue, especially in complicated revision surgeries. Autologous tissue provides greater stability and more natural results compared to synthetic materials. It's essential to aim for natural, sustainable designs rather than pursuing overly ambitious changes, as this approach tends to yield better long-term results.
For those considering rhinoplasty, especially revision surgery, I strongly encourage you to consult with a surgeon who has both extensive experience and specialized expertise. At Nose Lab Clinic, we combine in-depth anatomical knowledge as ENT specialists with vast surgical experience to offer personalized surgical plans tailored to each patient's unique needs.
We are committed to helping you achieve a beautiful and healthy nose.
This has been Dr. Cha-Young Kang, head surgeon at Nose Lab Clinic.Thank you.
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