Case of Contracted Nose and Mesh Removal Revision Rhinoplasty_Rhinoplasty Korea

Hello, this is Dr. Cha-Young Kang, head surgeon at Nose Lab Clinic.

Today, I would like to present a complex revision rhinoplasty case involving a patient with a contracted, upturned nose after multiple surgeries and inflammation. The patient struggled with issues such as a contracted nose, upturned nasal tip, short nose, and nostril asymmetry, and sought help at our clinic.

1. Design Consultation

We conducted a detailed analysis of the patient’s condition:

Pre-Surgery Design Consultation: Frontal, Left Oblique, and Left Profile Views

Frontal View:

• The nose appeared short and upturned overall.

• There was significant nostril visibility.

• Nostril asymmetry was evident.

• The nasal bridge was flat, with a high starting point.

Oblique View:

• The nasal tip drooped while being upturned, creating a contradictory shape.

• The entire nose appeared short.

• The nasolabial angle (the angle between the nose and the upper lip) was large.

Profile View:

• The nasal bridge had a high starting point.

• The nasolabial angle was large.

• The nasal tip was upturned.

Pre-Surgery Design Consultation: Right Oblique, Right Profile, and Nostril Views

Nostril View:

• Nostril asymmetry was prominent.

• The columella (the tissue between the nostrils) was tilted to the right.

• The nasal tip appeared small and weak.

2. Patient's Primary Requests

1. Correction of the upturned nose

2. Lowering the starting point of the nasal bridge

3. Improvement of nostril asymmetry

4. Overall lengthening of the nose

3. Surgical History

• 2017: Silicone implant insertion

• 2019: Silicone implant removal

• 2019: PRP (Platelet-Rich Plasma) x3 + Ear cartilage + Alloderm (artificial dermis)

• 2023: Donor rib cartilage + Philtrum reduction + Alar base reduction

• 2024: Stem cell injection treatment x3 at Nose Lab Clinic

4. Surgical Procedure

a) Unexpected Mesh Removal:

During surgery, unexpected mesh material was found in the nasal tip and was removed.

The previously used donor rib cartilage had mostly been absorbed, with only a small portion remaining, which was also removed.

Photos of Mesh Removal , 1. Artificial Dermis 2. Removed Mesh Fragments 3.Removed Donated Rib Cartilage Fragments

b) Total Septal Reconstruction:

• As most of the septal cartilage had disappeared, we used autologous rib cartilage to reconstruct the entire septum.

• This was essential for providing structural stability to the nose and correcting the upturned tip.

c) Septal Extension:

• To lower the upturned nasal tip, we performed septal extension using autologous rib cartilage.

• This improved the overall length of the nose and resolved the upturned nose issue.

d) Reconstruction of Alar Cartilage:

• The right alar cartilage had completely disappeared, and only about one-third remained on the left side. Both sides were reconstructed using autologous rib cartilage.

• This played a key role in improving the shape and symmetry of the nostrils.

e) Correction of Septal Deviation:

• Due to the mesh and deformed donor cartilage, the internal nasal space had become narrow. We corrected this using autologous rib cartilage for septal reconstruction.

• This procedure improved the patient’s nasal congestion.

f) Paranasal Augmentation (Grafting):

• Autologous rib cartilage was used for paranasal augmentation to improve the nasolabial fold (smile lines).

g) Nasal Bridge Line Formation:

• A natural dorsal line was created using autologous rib cartilage.

• Before completing the surgery, we demonstrated the new nasal bridge contour by placing the cartilage in position and checking the line.

"This shows the insertion of autologous rib cartilage into the nasal bridge before suturing and confirming the line."

All procedures were performed using a closed approach, completing the surgery without any external scarring

5. Before and After Photo Comparison

Upon reviewing the immediate post-surgery photos, the following improvements can be observed:

Frontal view before surgery (left) after surgery (right)

Frontal View:

• The previously upturned nose has been naturally lowered, resulting in a more stable and balanced appearance.

• The nose, which appeared short, has been lengthened to a more natural proportion.

• The nostril asymmetry has been significantly improved, achieving better symmetry.

• The philtrum now appears shorter, which has enhanced the overall facial proportions.

45-degree angle view before surgery (left) after surgery (right)

Oblique View:

• The starting point of the nasal bridge has been lowered, creating a more natural transition from the forehead to the nose.

• The previously short and droopy nasal tip has been corrected, achieving better balance.

• The nasolabial angle has been adjusted to approximately 95 degrees, improving the harmony between the nose and mouth.

Side profile view before surgery (left) after surgery (right)

Profile View:

• The previously high starting point of the nasal bridge has been lowered for a more natural profile.

• The upturned nasal tip has been naturally corrected, resulting in a smooth, balanced nasal line.

• The nasolabial angle has been corrected to about 95 degrees, improving the balance between the nose and the lips.

• The overall dorsal line of the nose has become more natural and aesthetically pleasing.

Nostrils before surgery (left) after surgery (right)

Nostril View:

• The previously significant nostril asymmetry has been greatly improved, resulting in more balanced nostrils.

• The columella, which was tilted to the right, has been realigned.

• The width of the columella has been refined, resulting in a more proportional and natural nasal base.

6. Final Evaluation

This case highlights a successful correction of a complex contracted and upturned nose due to multiple previous surgeries and inflammation. The use of autologous rib cartilage for total septal reconstruction and extension was the key to the surgery’s success. Additionally, the reconstruction of the alar cartilage allowed for significant improvement in the severe nostril asymmetry. The unexpected discovery and removal of mesh material and deformed donor cartilage were crucial in resolving the patient's nasal congestion, making this case not only a cosmetic improvement but also a functional enhancement.

7. Closing Remarks

For those dealing with complex nasal issues such as contracted nose, upturned tip, short nose, or nostril asymmetry, I hope this case provides hope and insight. Even in cases with multiple previous surgeries or complications such as inflammation, it is possible to achieve satisfying results with the right surgical plan and techniques.

In such complex cases, it is especially important to choose a surgeon with extensive experience and expertise. At Nose Lab Clinic, we create personalized surgical plans for each patient based on deep anatomical knowledge and a wealth of surgical experience.

Rhinoplasty is not just about aesthetics; functional improvements are equally important. Therefore, a comprehensive approach that considers both cosmetic and functional aspects is essential. At Nose Lab Clinic, we always prioritize patient safety and satisfaction, striving to create a natural and healthy nose.

We are here to help you achieve a beautiful and healthy nose.

This has been Dr. Cha-Young Kang, head surgeon at Nose Lab Clinic.

Thank you.