Hello, this Dr. Chayoung Kang, Director of Noselab Rhinoplasty Clinic. Today I will introduce a very special case: In the span of 30 years, the patient had undergone complex nose surgery, and currently presented a perforation of the septal cartilage of approximately 2cm wide. Let's take a look at the patient's surgical transformation and positive change.
Case history and initial consultation
The patient's complex surgical history is as follows:
Rhinoplasty using an L-shaped silicone implant 30 years prior.
Reoperation in 2010, using silicone once again.
Silicone removal in 2012, followed by gluteal dermis transplant.
The patient's main concerns were:
Nostril asymmetry and abnormal shape.
Flat, wide andd upturned-looking nose.
Saddle-shaped lower nasal dorsum.
Symptoms related to the septal performation (nasal congestion, nosebleeds, forming of nasal scabs)
Preoperative analysis
Frontal view:
Prominent nostril asymmetry
A generally wide-looking nose
Unnaturally upturned nose tip
Side profile view:
Flat and saddle-like nasal dorsum shape
Upturned and short nose tip
High nasal bridge starting point
45-degree angle view:
Overall unnatural nose contour
Visible skin tension caused by the contracture deformity.
Nostrils:
Severe asymmetry
Wide nostrils
Surgical plan
After determining the complexity of this case, we developed a 2-stage plan:
Stage 1 (three months earlier)
Local flap surgery using submucosal membrane from the inferior turbinates to restore the septal perforation.
Nasal endoscopy septal performation photo
Stage 2 (current surgery)
Septal reconstruction surgery to correct the saddle nose.
Septal extension graft usisng autologous rib cartilage to correct the upturned and short-looking nose.
Alar lowering surgery to improve the asymmetric nostrils.
Alar cartilage relocation and tying in order to correct the bluntness of the nose tip.
Removal of the existing implant to lower the nose bridge starting point.
General nasal reconstruction using autologous rib cartilage.
Contractured tissue removal to release the skin on the nose tip.
Before and After Surgery Photos
Nostril asymmetry improvement
Changed the wide nose into a more sophisticated and slimmer shape.
Facial balance improvement by lowering the upturned nose tip.
Transformed the saddle-shaped nasal dorsum into a smooth shape.
Adjustment of the lenght of the nose, which helped improve the appearance of the mouth protrusion.
The shape of the nose became overall more balanced after lowering the previously upturned nose tip.
Enhancement of the nose contour to be more beautiful and natural-looking.
A softer shape appearance can be observed thanks to the alleviation of the tense skin caused by the nasal contracture.
Great improvement of the severe nostril asymmetry
Improvement of the wide areas of the nostrils.
After surgery table photos
Overview
This case is a successful case of correction under extremely difficult conditions, including a complex surgical history and a large septal perforation. In particular, we can highlight the following aspects:
1) Treatment of the 2cm septal perforation:
When the size of the septal perforation exceeds 2 cm, the success rate of the surgery decreases sharply. In this case, a large perforation was successfully closed through a 2-stage approach. This is an outcome that would not have been possible without a high level of expertise and experience.
2) Comprehensive solution to complex problems:
We have solved various problems at the same time, such as a deviated, short, wide nose a[[earance, and contracture deformity. This was possible because we did not simply treat each problem individually, but took a comprehensive approach that considered the structure and function of the entire nose.
3) Reconstruction using autologous tissue:
By reconstructing the nasal septum, alar, etc. using autologous costal cartilage, we were able to achieve long-term, stable, and natural results.
4) Advantages of the closed rhinoplasty approach:
Even in such complex cases, the use of a closed rhinoplasty approach allowed us to complete the surgery without external visible scars and shorten the recovery period.
Conclusion
The rhinoplasty plan for patients presenting septal perforation varies greatly in treatment plan and method depending on the size and location of the perforation. In principle, there is no need to treat a perforation if this does not cause symptoms, but if symptoms such as nasal congestion, nosebleeds, and nasal scabs are present like in this patient's case, treatment is necessary.
In particular, if the perforation is located in the front, there is a risk that the transplanted cartilage will be exposed during septal extension surgery, which is essential for rhinoplasty, so it must be covered. However, large perforations larger than 2 cm drastically reduce the success rate of the surgery, so you must receive treatment from an experienced otolaryngologist.
The successful resolution of such a complex case was possible because of Dr. Kang's anatomical knowledge, abundant surgical experience, and closed rhinoplasty know-how as an otolaryngologist. Noselab Clinic will continue to take on the challenge of making the ‘impossible’ into the ‘possible’.
We hope this case will be a source of hope for those who are suffering from septal perforation or complicated nasal problems. No matter how difficult the case may be, it can be solved through proper diagnosis, treatment plan, and professional treatment. Through a comprehensive approach that simultaneously considers functional and cosmetic improvements, we aim to create beautiful noses that breathe easy.
With Noselab Clinic you can achieve a beautiful and healthy nose!
Thank you.
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