Reoperation: Hoping to correct a contractured nose tip.

Hello, this is Dr. Chayoung Kang, Director of Noselab Rhinoplasty Clinic. Today, we will introduce a rhinoplasty case of a patient who had undergone several rhinoplasty surgeries and developed nasal contracture deformation due to inflammation.

In this complex revision rhinoplasty case, we can clearly observe its difficulty and its resolution process.

Preoperative Design Consultation

This patient wanted to correct her wide nose and excessively exposed nostrils that looked strange from the side profile. The patient’s medical histpry is as follows:

  • 2009: silicone + ear cartilage
  • 2010: silicone + autologous dermis
  • 2012: silicone + autologous rib cartilage
  • 2015: silicone + autologous rib cartilage
  • 2022: silicone removal due to inflammation
  • 8 months later: autologous rib cartilage for the nose tip only + ear cartilage + stem cell injection treatment
Preoperative design consultation, frontal view, 45-degree view and side profile view.
Nostril view

Frontal view:

  • Excessively exposed and asymmetrical nostrils.
  • Barely any nostril contour and a wide and blunt appearance.
  • Plain nose bridge

45-degree angle view:

  • Flat glabella
  • Upturned and blunt nose tip

Side profile:

  • Flat glabella and high nasal dorsum
  • Short and upturned nose tip
  • Wide nasolabial angle and protruding mouth

Nostrils:

  • Asymmetric nostrils
  • The skin transplanted in the previous nostril lowering surgery was tilted on the side of the nostrils.

Surgical Plan

After determining the unsatisfactory parts of the patient’s condition, we came up with the following plan:

  • Stem cell injection tretament: 3 sessions with 2-week intervals in order to soften the skin of the nose.
  • Septal extension and reconstruction using the autologous rib cartilage.
  • Partial subcutaneous tissue removal.
  • Lateral osteotomy.
  • Nasolabial angle correction surgery
  • Partial use of a silicone implant on the nose tip.
  • Making of a semi-curved nose shape.

Before and After Surgery Photos

Frontal view before surgery (left) after surgery (right)
  • The excessively exposed nostrils became more natural.
  • Great improvement of the nostril asymmetry.
  • The wide and blunt nose tip became more delicate-looking.
  • The plain nasal bridge was adjusted in height and contour.
Side profile view before surgery (left) after surgery (right)
  • The flat glabella was raised naturally.
  • The blunt and upturned nose bridge improved the overall line to make it smoother.
45-degree angle view before surgery (left) after surgery (right)
  • Balance improvement between the glabella and the nose bridge.
  • The short and upturned nose tip was adjusted and corrected into a more harmonious shape.
  • Natural-looking improvement of the wide nasolabiala angle and the protruding mouth.
Nostrils before surgery (left) after surgery (right)
  • Great improvement of the nostril asymmetry.
  • Natural-looking correction of the skin remaining from the previous nostril lowering surgery.

After Surgery Table Photos

Photos taken immediately after surgery, frontal view, 45-angle view, and side profile.
Photo of the nostrils

Overview

This case was a very complex case of a patient who had undergone multiple rhinoplasties and that had developed deformation due to inflammation. In such cases, a comprehensive approach is needed that considers not only the cosmetic improvement but also the functional aspects of the nose.

The biggest challenge was that there was almost no normal cartilage tissue left inside the nose. This could be a big problem not only in terms of aesthetics but also in terms of functionality. Therefore, septal reconstruction and alar cartilage reconstruction using autologous costal cartilage were essential.

​In addition, it was very important to smooth the contractured skin. To do this, we performed stem cell injection treatment in advance, and the constructed tissue on the bridge of the nose was carefully removed during the surgery. During this process, damage to normal tissue was minimized, and special attention was paid to blood vessel damage. This plays an important role in preventing skin necrosis and helping postoperative recovery.

​Through this surgery, the patient’s overall nose shape was naturally improved. The spread and upturned nose tip was corrected, the height and contour of the bridge of the nose were improved, and the overall facial balance was improved through the correction of the nasolabial angle.

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