Correcting Nasal Obstruction and Nostril Asymmetry: A Complex Revision Rhinoplasty Case

Hello, this is Dr. Cha-Young Kang, Director of Nose Lab Clinic.

Today, I’ll share the case of a patient who came to us with concerns about nasal obstruction and nostril asymmetry. In this patient’s case, previous surgeries had caused internal nasal adhesions, which led to severe nasal blockage.

1. Surgical History and Goals

Surgical History:

• 2021: Ear cartilage and filler injections

• 2022: Septal cartilage, autologous rib cartilage, and Gore-Tex implant

• October 2022: Philtrum reduction

• 2023: Augmentation surgery

Patient’s Goals:

• Address nasal obstruction on both sides

• Correct nostril asymmetry

• Reduce nostril visibility

• Achieve a natural, refined nasal appearance

2. Pre-Surgical Analysis

In our design consultation, we observed the following:

• Front View: The nasal tip deviated slightly to the left, with noticeable asymmetry in nostril shape and visibility.

• Side View: The nasal tip drooped slightly, and a dorsal hump was present. The starting point of the bridge was high, and the nasolabial angle appeared to exceed 95 degrees.

• Nostril View: The columella deviated slightly to the right, and the left nostril appeared smaller and longer than the right.

A CT scan of the nose taken during the patient's visit showed findings of a deviated nasal septum and mucosal adhesions within the nasal cavity. These mucosal adhesions were also confirmed upon nasal endoscopy examination.

Mucosal Adhesion Between the Nasal Septum and Inferior Turbinate (Arrow)

3. Surgical Plan

To address both the functional and aesthetic concerns, we developed the following surgical plan:

1. Septal Extension with Autologous Rib Cartilage: To provide structural stability and correct the upturned tip

2. Septal Reconstruction: Shifting the septal cartilage to the right to address the deviation and improve airflow

3. Nostril Lengthening: Repositioning and reinforcing the alar cartilage to correct asymmetry and reduce visible nostril area

4. Replacement of Gore-Tex Implant: Removing the Gore-Tex and replacing it with a silicone implant, positioned to start slightly lower for a more natural look

5. Alar Cartilage Adjustment and Suturing: To refine the nasal tip shape

6. Nasolabial Angle Adjustment: Correcting the angle using autologous rib cartilage for a more balanced appearance

   

Removed Gore-Tex Implant

In cases where prior surgeries have damaged the cartilage, our standard approach is to reconstruct or restore normal anatomical structure using autologous rib cartilage. To ensure safe cartilage harvesting, we identified the rib with the least calcification using a chest X-ray. This patient’s ribs had extensive calcification on both sides, so we partially harvested from the right 8th rib.

Additionally, given the high risk of re-adhesion with nasal obstruction surgery, we took careful measures to prevent future adhesion and ensure lasting improvement.

4. Post-Surgical Results

Before Surgery (Left) / Immediately After Surgery (Right)

Side View:

• The drooping tip was completely corrected, and the dorsal hump was removed. The nasolabial angle now appears natural and balanced.

Oblique View:

• The bridge’s starting point aligns naturally with the pupil line, creating a harmonious profile.

Front View:

• The most dramatic improvement was visible from the front, where the nostril visibility was reduced by more than half, and asymmetry was significantly corrected. The previously deviated nose is now much straighter.

Nostril View:

• The nostril asymmetry was corrected through septal reconstruction, shifting the septal cartilage to the right. This repositioning resulted in a noticeably improved alignment of the columella and balanced nostril appearance.

Let’s gather only the photos taken immediately after surgery:

Frontal, Oblique Side, and Side Photos Immediately After Surgery

Nostril View Immediately After Surgery

5. Conclusion

Revision rhinoplasty for nostril asymmetry and an upturned tip requires careful planning and the selection of a specialized medical team. It’s crucial to choose a hospital with experience handling potential complications during surgery and recovery. Nasal obstruction and septal reconstruction surgeries fall within the realm of ENT specialists, so selecting a facility with this expertise is especially important.

I hope this case provides insight for those facing similar challenges. At Nose Lab Clinic, we are committed to helping our patients achieve both functional and aesthetic improvements.

Thank you,

Dr. Cha-Young Kang, Director of Nose Lab Clinic.