When patients undergo double jaw surgery followed by rhinoplasty, unique challenges can arise that require specialized expertise. Today, we explore a complex revision case at Noselab Plastic Surgery involving long nose correction for a patient with a history of both procedures.
Patient Background and Initial Assessment
This patient presented at Noselab Clinic with a complex surgical history. Fourteen years prior, they had received nose filler, which was later removed at another hospital along with rhinoplasty using ear and septal cartilage. Despite this surgery, the nose remained long and droopy, prompting them to seek revision surgery.
Having previously undergone double jaw surgery, I suspected weakened septal cartilage—a common complication in patients with long nose deformity following facial contour procedures.
Preoperative Consultation Findings
During the initial examination, several concerns were evident. The glabella appeared tall and the nose looked elongated. From the frontal view, the nose appeared overall blunt and wide, which added years to the patient’s appearance.
The side profile revealed a long, droopy tip with apparent mouth protrusion. The nasolabial angle was small, and the transition from nose tip through the philtrum to the lips lacked natural harmony.
Nostril photographs showed noticeable asymmetry and size differences—likely a consequence of structural changes from the double jaw surgery.
Surgical Planning for Long Nose Correction
Given the weakened septal cartilage from the previous double jaw surgery, strengthening this foundation was the primary focus. The long, droopy appearance indicated compromised structural support, so I planned septal cartilage reconstruction using autologous rib cartilage.
The patient’s records indicated filler removal during the previous surgery, but clinical examination suggested considerable filler remained. Thorough filler extraction became an essential component of the surgical plan.
The blunt tip appearance was attributed to extensive scar tissue formation. Subcutaneous tissue removal was planned to reduce skin thickness and improve definition. For the nasal bridge, foreign substance removal followed by silicone implant placement would restore proper height and contour.
Before and After Results
The transformation achieved through this revision rhinoplasty demonstrates significant improvement across all angles.
Side Profile View
The nasal bridge starting point has been lowered considerably, creating better facial harmony. The nasolabial angle shows marked improvement, and the previously blunt tip now appears refined and natural.
45-Degree Oblique View
From this angle, the tip refinement is particularly evident. The nose tip appears slimmer and more defined, with smoother contours along the entire nasal structure.
Frontal View
The previously blunt and deviated appearance has improved dramatically. Some temporary redness on the nasal dorsum from foreign substance removal will resolve quickly. Nostril asymmetry has been corrected significantly.
Nostril View
The right nostril, which previously showed severe asymmetry, now closely matches the left side. The overall nostril shape appears balanced and natural.
Understanding the Connection Between Double Jaw Surgery and Rhinoplasty
Facial contour surgery, particularly double jaw surgery, can significantly impact rhinoplasty outcomes. Double jaw surgery involves separating and repositioning both the upper and lower jaw bones. Critically, the point where the upper jaw separates from the facial skeleton lies directly beneath the septal cartilage.
This anatomical relationship means double jaw surgery can weaken or damage the septal cartilage, affecting any subsequent rhinoplasty involving septal extension grafts.
Key Considerations for Post-Double Jaw Rhinoplasty
Cartilage Source Selection: Weakened septal cartilage makes harvesting adequate material difficult. Stronger alternatives such as autologous rib cartilage or donated rib cartilage often become necessary.
Structural Reinforcement: When the anterior septal cartilage is compromised, standard septal extension grafts risk complications including tip bending or drooping. Comprehensive septal cartilage reconstruction creates the necessary structural foundation to prevent future deformation.
Conclusion
For patients who have undergone double jaw surgery and are considering rhinoplasty, understanding these complexities is essential. The structural changes from facial contour surgery require specialized surgical approaches to achieve optimal, lasting results.
At Noselab Plastic Surgery, we specialize in complex revision rhinoplasty cases, including those involving prior facial contour procedures. Our approach prioritizes structural integrity to ensure beautiful, stable outcomes.
Dr. Chayoung Kang
Director, Noselab Plastic Surgery