Hello, I’m Dr. Cha-Young Kang, Director of Nose Lab Clinic.
Today, I’ll discuss a complex revision case for a contracted nose (also known as “contracture nose”) resulting from previous rhinoplasties. This case illustrates the importance of meticulous planning and the use of autologous rib cartilage for a successful reconstructive outcome.
Design Consultation: Frontal View, Left Side View, and Oblique Side View
1. Patient Information and Symptoms
Surgical History:
1st Surgery: Silicone implant + Ear cartilage graft + Nostril reduction
2nd Surgery: Autologous rib cartilage revision
3rd Surgery: Additional A/S procedure
Primary Symptoms:
Upturned, visible nostrils
Excessively elevated nasal tip
Scar tissue accumulation
Difficulty breathing
2. Pre-Surgical Analysis
Right Side View, Oblique Side View, and Nostril Photos
Front View:
Overly elevated nasal tip with nostril asymmetry
Side View:
Sharp, upturned nasal tip creating a shortened, unnatural appearance
Nostril View:
Columella deviated to the left, elongation of left nostril with visible scarring
Nasal obstruction: deviated septum, external nasal valve collapse
3. Surgical Plan and Procedure
Given the complexity of the issues, we aimed to address structural and aesthetic corrections comprehensively.
Primary Procedures:
Septal Reconstruction with Autologous Rib Cartilage: Reinforced the septum using rib cartilage to support and reposition the nasal tip, enabling a more natural downward orientation.
Inflammatory Granulation Tissue Removal: Removed inflamed tissue around the nasal tip to eliminate sources of irritation and prevent future contracture.
Nostril Lowering: Corrected nostril asymmetry by lowering the nostril base, improving both function and aesthetics.
Columella Adjustment: Lowered the columella for a balanced, natural look.
Alar Cartilage Reconstruction and Repositioning: Adjusted and sutured the nasal wing cartilage to improve nostril symmetry.
External Nasal Valve Reconstruction: Widened the nasal valve area to address breathing issues related to nasal collapse.
Before (Left) / Immediately After (Right)
Before (Left) / Immediately After (Right)
Before (Left) / Immediately After (Right)
Before (Left) / Immediately After (Right)
4. Post-Surgery Outcome
The revision successfully addressed the patient’s primary concerns:
Nasal Tip and Nostril Positioning: The sharp, upturned nasal tip now has a more natural appearance, with the nasolabial angle reduced, eliminating the previously visible nostrils from the side view.
Nostril Shape Improvement: The previously pointed, asymmetrical nostrils now appear more rounded and symmetrical.
Structural Reinforcement and Functional Restoration: By widening the nasal valve area and addressing septal deviation, the patient’s breathing difficulties have been significantly alleviated.
Final Thoughts
Following this complex surgery, the patient will continue with antibiotic injections for inflammation control. We also plan to incorporate stem cell therapy for contracture prevention and will evaluate the need for a follow-up corrective procedure in six months.
Contracted nose revisions require a systematic, staged approach, often involving structural re-stabilization before focusing on finer aesthetic details. At Nose Lab Clinic, our extensive experience with complex revisions allows us to provide comprehensive and safe outcomes.
For those considering rhinoplasty revision, we highly recommend consulting with a surgeon experienced in managing complicated cases to ensure a personalized and effective treatment plan.
Thank you for reading. This is Dr. Cha-Young Kang, Director of Nose Lab Clinic.
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