Hello, this is Dr. Cha-Young Kang, head surgeon at Nose Lab Clinic.
Today, I will introduce a complex revision rhinoplasty case where we successfully corrected severe nasal deformities caused by over-aggressive nostril reduction surgery, as well as saddle nose and retracted nostrils. The patient had undergone several nasal surgeries that led to significant nasal deformities. We will explore how we tackled these challenges and achieved successful results.
1. Patient's Surgery History
17 years ago: Autologous rib cartilage + silicone implant surgery
February 2022: Height-enhancing revision surgery
October 2022: Autologous rib cartilage + silicone + nostril reduction surgery
Late 2022: Onset of nasal contracture deformity
December 2023: Philtrum reduction surgery
2. Patient's Main Symptoms and Requests
Severe nasal obstruction on both sides
Dislike the pointed and overly exposed nostrils
Desire to maintain current nose height (do not want it lowered)
3. Design Consultation
Frontal View:
The nasal tip appears bulbous and retracted.
Nostril asymmetry is visible.
The nostrils appear pointed and overly exposed.
Oblique View:
The nasal tip appears droopy.
The nostrils are overly exposed.
The alar region looks pinched.
Side View:
The nasal tip is drooping.
The alar region appears pinched.
Nostril View:
Nostril asymmetry and pinching are present.
The nostrils are excessively narrowed.
4. Surgery Plan
Based on the patient’s condition and concerns, we developed the following surgical plan:
a) Pre-surgery stem cell injection treatment (3 sessions, 2 weeks apart)
b) Autologous rib cartilage graft for septal reconstruction
c) Lowering of the columella
d) Alar cartilage reconstruction surgery
e) Skin and dermal grafting inside the nostrils
5. Surgery Details
We performed the surgery as per the following plan:
The blue arrow indicates the right rib cartilage that is scheduled for harvesting.
a) Autologous Rib Cartilage Harvest:
A chest X-ray prior to surgery revealed significant calcification in the rib cartilage.
The least calcified area (either the 6th or 7th rib) was partially harvested.
However, during surgery, the calcification was severe, and only a small amount of cartilage could be collected.
b) Nasal Tip Reconstruction:
The previously used autologous rib cartilage, along with the newly harvested cartilage, was used to reconstruct the nasal tip.
c) Septal Reconstruction:
The internal nasal passage was widened to improve nasal airflow.
d) Alar Correction:
The pinched alar area was corrected through cartilage reconstruction and skin-dermal composite grafting inside the nostrils.
6. Pre- and Post-Surgery Photo Comparison
Frontal view before surgery (left) after surgery (right)
Frontal View:
The pinched nostrils have been naturally corrected.
The bulbous and broad nasal tip has been refined.
The short-looking nose has been elongated to create a more balanced appearance.
45-degree angle view before surgery (left) after surgery (right)
Oblique View:
The overly exposed nostrils have been improved.
Side profile view before surgery (left) after surgery (right)
Side View:
The pinched, upward-lifted alar area has been corrected naturally.
Nostrils before surgery (left) after surgery (right)
Nostril View:
The pinched appearance of the nostrils has been improved.
Nostril asymmetry has been corrected.
The elongated nostrils now appear rounded and more balanced.
7. Conclusion
In this patient’s case, the main issue was the reduced size of the nasal skin due to contracture caused by inflammation. However, an even greater challenge was the severe reduction of nostril size and skin shrinkage caused by over-aggressive nostril and philtrum reduction surgeries.
Improving nasal obstruction would usually require enlarging the nostrils. However, nostril enlargement surgery is very difficult with low success rates, so we did not opt for this procedure in this case. Instead, we focused on reshaping the nostrils and reducing the nasal tip height to effectively widen the nostrils.
This complex case required a carefully tailored approach that addressed the patient's condition and needs. By utilizing autologous rib cartilage for reconstruction and skin-dermal composite grafting, we were able to correct both the contracture deformity and retracted nostrils.
8. Final Thoughts
For those struggling with complications from over-aggressive nostril reduction, saddle nose, or retracted nostrils, I hope this case provides hope. These complex issues require a customized approach, and in many cases, multiple stages of treatment may be necessary.
At Nose Lab Clinic, we have the expertise and experience to handle even the most challenging cases safely and effectively. If you’re dealing with complications such as nasal contracture or retracted nostrils after nasal surgery, I encourage you to consult with a specialist to find the best solution for your situation.
We’re committed to helping you achieve a healthy and beautiful nose.
This has been Dr. Cha-Young Kang, head surgeon at Nose Lab Clinic.
Thank you.
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