[Nose Lab Clinic]
Hello, this is Dr. Cha-Young Kang, Director of Nose Lab Clinic.
Today, I’d like to share a complex revision rhinoplasty case involving a patient with a thick columella and an upturned nose. The patient had undergone multiple surgeries and dealt with inflammation and recurring use of autologous rib cartilage, making this case particularly challenging.
1.Desired Outcome
2. Preoperative Analysis
Design Consultation: Frontal View, Left Side View, and Oblique Side View Photos
a. Frontal View
Bulbous and wide nasal tip.
Pinched appearance on both sides.
Excessively visible nostrils.
Nostril asymmetry.
b. Side View
Upturned nasal tip.
Large nasolabial angle.
Irregular and uneven dorsal line.
Unnatural contour.
Design Consultation: Nostril View, Right Side View, and Oblique Side View Photos
c. Nostril View
Severe asymmetry.
Thick columella.
Reduced nostril size.
Irregular nostril shape.
3. Intraoperative Findings
During surgery, the following issues were identified:
Severe damage to the septal cartilage, leaving almost no structural support.
Nearly absent alar cartilage, requiring complete reconstruction.
Presence of extensive scar tissue and foreign material along the nasal dorsum.
Partial absorption of previously used autologous rib cartilage.
Preoperative chest X-rays revealed significant calcification in both rib cartilages. Given the patient’s history of two prior cartilage harvests from the right side, the left rib cartilage with minimal calcification was carefully selected and harvested safely.
4. Surgical Approach
a. Structural Reconstruction
Complete septal cartilage reconstruction using autologous rib cartilage.
Full alar cartilage reconstruction and reinforcement.
Cartilage repositioning and grafting to ensure tip support.
Narrowing the columella width.
b. Scar and Foreign Material Management
Complete removal of scar tissue and residual foreign materials.
Optimization of stretched skin.
Thinning and reshaping of the columella.
c. Functional Improvement
Correction of septal deviation.
Concurrent surgery for chronic rhinitis.
Additional measures to alleviate nasal obstruction.
5. Postoperative Results
Before (Left) / Immediately After (Right)
a. Frontal View
Improved balance and symmetry.
Reduced nostril visibility.
Corrected nostril asymmetry.
Resolved pinched appearance.
Enhanced overall harmony.
Before (Left) / Immediately After (Right)
b. Side View
Naturally aligned nasal tip.
Normalized nasolabial angle.
Smooth dorsal line.
Aesthetic and harmonious profile.
Before (Left) / Immediately After (Right)
c. Nostril View
Normalized columella width.
Balanced nostril shape and size.
Restored symmetry.
Natural appearance.
Before (Left) / Immediately After (Right)
6. Expert Insight
Immediately After Surgery: Frontal, Side, and Oblique Side View Photos
Immediately After Surgery: Nostril View Photos
This case posed significant challenges due to multiple revision surgeries, inflammation, repeated use of autologous rib cartilage, and prior philtrum reduction surgery. The successful outcome was achieved through the following principles:
Maximum Reconstruction of Normal Structures: Ensuring structural integrity to support long-term stability.
Safe Removal of Foreign Materials: Minimizing risks of recurrence or complications.
Stepwise Correction of Contracture: Addressing each issue in stages for optimal results.
Balance Between Function and Aesthetics: Achieving harmony in both appearance and breathing function.
This case underscores the importance of meticulous analysis, strategic planning, and experienced surgical execution for complex revision cases.
At Nose Lab Clinic, we remain committed to providing safe, effective, and tailored surgical solutions to meet the unique needs of every patient.
Thank you for reading this case study.
This is Dr. Cha-Young Kang, Director of Nose Lab Clinic.
Thank you!
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