Case of Contracted Nose Correction Due to MRSA Infection_Rhinoplasty Korea

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

Today, I would like to introduce a case of contracted nose correction due to MRSA infection. This patient had undergone two prior surgeries, including alar base reduction and philtrum reduction, before requiring a third revision surgery.

The patient developed MRSA infection after the second surgery. This was due to tissue necrosis from exposing the nasal mucosa to high humidity and steam before the sutures were removed, resulting in an acute infection. The inflammation was treated with the removal of the nasal implant and partial removal of the nasal tip cartilage, followed by aggressive antibiotic therapy. Afterward, the patient received three stem cell injections and proceeded with surgery using autologous rib cartilage.

1. Pre-Surgery Design Consultation

A detailed analysis of the patient’s condition before surgery showed the following:

Pre-Surgery Design Consultation: Frontal View, Left Oblique Side View, and Left Side View

Frontal View:

• The nose appeared broad and spread.

• Nostril asymmetry was pronounced.

• The nasal bridge appeared crooked.

Profile View:

• The nasal tip was droopy.

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

• Due to two prior philtrum reduction surgeries, the transition from the columella to the philtrum appeared unnatural.

Oblique View:

• The nasal tip appeared droopy.

• The columella was hanging and looked low.

Pre-Surgery Design Consultation: Right Oblique Side View, Right Side View, and Nostril Photos

Nostril View:

There was a visible scar from a prior open rhinoplasty.

The left nostril was collapsed and nostril asymmetry was evident.

Patient’s Requests:

• Correction of the broad nose.

• Correction of the droopy nasal tip.

• Refinement of the bulbous tip

• Correction of the crooked nose.

• Improvement of nostril asymmetry.

2. Surgical Plan

Taking the patient’s condition and requests into account, the following surgical plan was developed:

a) Examine nasal cartilage condition and perform reconstruction as needed.

b) Septal extension graft using autologous rib cartilage to support and refine the droopy, bulbous nasal tip.

c) Lateral osteotomy and dorsal augmentation using autologous rib cartilage to straighten the crooked, broad nasal bridge.

d) Evaluate the condition of the alar cartilage and reconstruct if necessary.

e) Alar cartilage repositioning and cartilage suturing to improve nostril asymmetry.

f) Nasolabial angle correction by anchoring the columella to the septal cartilage.

3. Surgical Procedure

The surgery was performed using a closed (endonasal) approach with the following procedures:

a) Septal Reconstruction:

• Severe inflammation had caused significant absorption of the existing septal cartilage and previous rib cartilage grafts. Using fresh autologous rib cartilage, the septum was fully reconstructed.

• 
  

b) Lateral Osteotomy:

• To correct the spread and crooked nasal bones, a precise lateral osteotomy was performed to narrow and straighten the nasal bridge.

c) Alar Cartilage Reconstruction and Repositioning:

• The damaged left alar cartilage was repaired and made symmetrical with the right side.

• The alar cartilage was repositioned and sutured to improve nostril asymmetry.

d) Septal Extension Graft:

• Autologous rib cartilage was used to extend the septum, providing support for the droopy nasal tip and improving its projection and structure.

e) Dorsal Augmentation:

• The nasal bridge was augmented using autologous rib cartilage to elevate the profile and correct the crooked appearanc

f) Nasolabial Angle Correction:

• The columella was anchored to the septal cartilage to correct the nasolabial angle, creating a natural transition between the nose and lips.

4. Before and After Photo Comparison

The comparison of the immediate post-surgery photos shows the following improvements:

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

Frontal View:

• The previously broad and crooked nasal bridge has been straightened, giving a more natural and aligned appearanc

• The nostril asymmetry has been significantly improved.

• The overall contour of the nose is now more refined and balanced, contributing to a more harmonious facial appearance.

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

Profile View:

• The droopy and short nasal tip has been corrected to a straight, natural-looking line, enhancing the nose’s aesthetic.

• The nasolabial angle has been appropriately adjusted, resulting in better harmony between the nose and lips.

• The unnatural transition caused by previous philtrum reduction surgeries has been greatly improved.

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

Oblique View:

• The previously droopy and bulbous nasal tip has been refined, resulting in a sleeker and more sophisticated appearance.

• The entire nasal line is now smooth and natural, giving a balanced look.

Nostrils before surgery (left) after surgery (right)

Nostril View:

• The collapsed left nostril has been corrected, and the nostrils now have a more symmetrical shape.

• The nostril asymmetry has been notably reduced.

• The previously prominent scar from the open rhinoplasty on the columella has improved significantly, blending more naturally with the surrounding skin.

5. Post-Surgery Photo Collection

Photos Immediately After Surgery: Frontal View, Side View, and Oblique Side View

Photo of the nostrils

6. Final Evaluation

This case highlights the complexity and challenges of correcting a contracted nose due to MRSA infection. MRSA infections are particularly difficult to treat due to antibiotic resistance, and the resulting nasal contracture is one of the most challenging conditions in rhinoplasty.

In this patient, the severe inflammation caused substantial damage to the existing cartilage structure. The use of autologous rib cartilage for septal reconstruction and extension grafts played a crucial role in restoring structural stability and achieving the desired cosmetic improvements.

Additionally, the reconstruction and repositioning of the damaged alar cartilage to correct the nostril asymmetry was essential for enhancing the overall balance and symmetry of the nose. The lateral osteotomy helped straighten the crooked and broad nasal bridge effectively.

A notable aspect of this surgery is that these complex reconstructive procedures were performed using a closed (endonasal) approach, avoiding additional external scarring. This approach helped shorten the patient’s recovery time while maintaining a natural post-operative appearance.

7. Closing Remarks

I hope this case provides hope to those struggling with contracted nose due to MRSA infection. Preventing infections like MRSA after surgery is critical, as they can lead to serious complications. If such an infection does occur, early and accurate identification of the bacteria, followed by tailored antibiotic therapy based on sensitivity testing, is essential for effectively treating the infection. This step is the most crucial part of post-surgical infection management.

Correcting a contracted nose is a highly complex and challenging surgery. However, with the right surgical plan and precise techniques, satisfactory results can be achieved. It is particularly important in such cases to choose a surgeon with extensive experience and expertise in rhinoplasty.

At Nose Lab Clinic, we provide personalized surgical plans based on a deep understanding of ENT anatomy and years of surgical experience. We specialize in performing even the most complex revision surgeries using a closed (endonasal) approach, which allows us to avoid additional scarring while delivering optimal results.

For those considering rhinoplasty, especially those dealing with contracted nose correction, we highly recommend consulting with a specialist to find the best solution tailored to your unique needs. At Nose Lab Clinic, we are committed to helping you achieve a beautiful and healthy nose.

Thank you.

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