Hello, I am Dr. Chayoung Kang, Director of Noselab Clinic.
Today we will discuss about about the case of a patient with a high nasal bridge starting point, and high bridge, but a flat nose tip, which made the nose not three-dimensional enough, and therefore underwent surgery to lower the starting point, and heightening the nose tip to get a more sophisticated nose.
Preoperative Design Consultation
This patient had undergone 2 previous rhinoplasty surgeries, and a nostril reduction surgery. In the preoperative design consultation we found the following issues:
Frontal view
The starting point of the nasal bridge is abnormally high.
The nose looks generally tilted to the right side.
Visible nostril asymmetry.
Dent in the upper right alar.
Lateral view
The nose bridge is high but the nose tip is droopy, which makes it look plain.
Lack of volume.
Protruding mouth.
Retracted columella.
Wide nasolabial angle.
Oblique angle photo:
Since the starting point is so high, the nose bridge looks unnatural.
The nose tip looks droopy.
Nostril photo
Asymmetry caused by the previous nostril reduction.
Confirmed left nasal constriction.
Surgical Plan
The following plan was established accordingly to the patient’s needs and current condition:
a) Nose tip reconstruction and septal extension graft using autologous rib cartilage.
b) Septal deviation correction (constriction on the left side)
c) Lowering of the starting point of the nose bridge, and insertion of a new implant.
d) Creating a natural curve for the nose bridge.
e) Reconstruction of the right alar cartilage.
f) Additional cartilage graft to reinforce the sunken part in the skin on the upper part of the right alar.
The patient said that she wanted a sophisticated and high nose, but considering the size of the skin we planned to give the nose a sophisticated look as much as possible within a natural range. Moreover, we clearly explained to the patient about the limits caused by the nostril reduction (the nostril shape changes, the upturned nose phenomenom, etc.).
Surgery Content
At the time of the surgery, the condition of the patient resulted to be worse than we had predicted. The relevant contents of the surgery were the following:
a) Adhesion removal: The severe adhesion in-between the cartilage and the skin was carefully peeled off from the nose tip to the bridge starting point.
b) Septum reinforcement: We determined that the droopy nose tip was caused by the excessively thin and weak septal cartilage, so we strongly reinforced the cartilage using the self-rib cartilage.
c) Nose tip reconstruction: Elevating the nose tip as much as possible, and providing enhanced support using the self-rib cartilage.
d) Nasal bridge reconstruction: -We considered that the nasal bridge had become flat as consequence of the previous surgery, so we lowered the starting point and adjusted the overall height of the nose. – Removal of the existing implant, and inserting a new implant that exactly fits the nasal bone.
e) Alar reconstruction: Since the right alar cartilage was almost non-existant, we completely reconstructed it by using the autologous costal cartilage.
f) Additional correction: The existing ear cartilage was very damaged, so we performed a transplant on the right depressed area.
g) High-frequency laser inferior turbinates mucosal resection: To correct the hypertrophic rhinitis and improve the nasal congestion.
Every procedure was performed through closed rhinoplasty method.
Before and After Photos
The height of the nasal bridge starting point was lowered to look natural.
Straightening of the nose, which was deviated to the right side.
Improvement of the nostril asymmetry. However, due to the effect of the previous nostril reduction surgery, perfect symmetry is hard to achieve.
The nose contour became more clear in general.
As the nose tip was heightened appropiatedly, the droopy nose tip was improved.
The three-dimensional balance of the nose bridge and nose tip improved significantly.
Since the nose bridge took a curved shape, it became a elegant appearance.
The nasal bridge deviation was corrected, the nose bridge line is smooth now.
The droopy nose bridge was improved in general to a more balanced appearance.
By widening the left nasal cavity, the nasal congestion improved.
The condition of the right alar improved as it was reconstructed.
Due to the limitation caused by the previous nostril reduction, it cannot be perfectly symmetrical, however, we achieved overall balance.
Surgical Table Photos
Overview
This case was a complicated revision, in which the advantages and difficulties of the closed rhinoplasty method can be observed at the same time. Severe adhesion, damaged cartilage structures, bent prosthesis, and other various issues were successfully corrected. It is especially worth mentioning, the wide range of reconstruction using autologous costal cartilage that can be performed through closed rhinoplasty.
If the height of the nose bridge is increased forcefully, there is risk that the implant would come off-center, or bend. Furthermore, it is essential to design the area of the glabella naturally, since its height has a great impact on the appearance, it is the point important to know where the starting point should begin.
We considered the patient’s skin condition from the previous and the current surgery, to give the nose a sophisticated and three-dimensional appearance as much as possible within a natural range. Achieveing perfect symmetry would be difficult, but we achieved great functional and cosmetic improvements.
Closing remarks
Rhinoplasty, especially in the case of revision rhinoplasty, requires a meticulous approach tailored to every patient’s unique situation. It is possible to achieve natural results without scarring through the excellent method of closed rhinoplasty. However, it requires high-level skills and experience.
Therefore, I hope this case was of help to those who are concerned regarding complex revision rhinoplasty. It is essential to consult with an expert regarding the solutions that fit every individual’s case. We always think about our patients’ safety and satisfaction, we will try our best to provide the best results as possible.
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