Hello, this is Dr. Cha-Young Kang, head surgeon at Nose Lab Clinic.
Today, I’d like to present a revision rhinoplasty case involving a patient with a severely contracted nose due to inflammation. This case was particularly challenging due to significant skin damage, columellar depression, and nasal tip collapse. However, we were able to perform the surgery successfully while preserving as much of the skin as possible.
1. Surgical History
The patient had undergone the following previous surgeries:
July 2023: Rhinoplasty using Gore-Tex, septal cartilage, ear cartilage, and donor rib cartilage.
October 2023: Removal of nasal implants through nasal tip incision to treat inflammation.
2. Patient’s Requests
Rhinoplasty using autologous rib cartilage for the nasal bridge and tip.
Correction of the upturned, short nose.
Lowering the columellar depression (drooping the columella).
Scar correction on the nasal tip.
Correction of the nasolabial angle.
3. Pre-Surgery Design Consultation
After analyzing the photos taken during the consultation, the following issues were identified:
Pre-Surgery Design Consultation: Frontal, Left Oblique, and Left Profile Views
Frontal View:
Facial asymmetry was present.
The nasal bridge appeared broad and crooked.
Nostril asymmetry was significant.
Columellar depression was noted, creating an overall collapsed appearance.
Severe skin depression on the nasal tip, caused by the removal of the implants due to previous inflammation, was evident.
Profile View:
The nasal bridge was low overall.
The nasal tip was short and upturned, characteristic of a short nose (upturned nose).
The columellar depression was clearly visible, further contributing to the upturned appearance of the nose.
Oblique View:
The glabella (area between the eyebrows) was low, further flattening the profile.
The nasal tip was short and upturned, a typical feature of contracted nose.
Pre-Surgery Design Consultation: Right Oblique, Right Profile, and Nostril Views
Nostril View:
The deep scar on the nasal tip was removed, and the nostrils were more symmetrical.
The columella was raised, reducing its depression and improving nostril balance.
The previously asymmetrical nostril floor was corrected, improving the overall symmetry of the nostrils.
4. Surgical Plan
Considering the patient’s condition and requests, the following surgical plan was developed:
a) Nasal Tip and Bridge Reconstruction Using Autologous Rib Cartilage:
Since the patient had a contracted nose due to inflammation, we planned to use autologous rib cartilage, which offers greater safety and stability, to correct both the nasal tip and bridge.
b) Septal Reconstruction Surgery:
Depending on the condition of the septal cartilage, we planned a full reconstruction using autologous rib cartilage to restore nasal structure and function.
c) Septal Extension Graft:
To effectively lower and lengthen the short, upturned nose, a septal extension graft using autologous rib cartilage was planned.
d) Lateral Osteotomy and Dorsal Augmentation:
To correct the broad and crooked nasal bridge, we planned a lateral osteotomy along with dorsal augmentation using autologous rib cartilage.
e) Removal of Remaining Gore-Tex:
Any remaining Gore-Tex fragments from previous surgeries were planned to be fully removed, particularly those left around the nasal bridge.
f) Nostril Asymmetry Correction:
The condition of the alar cartilage would be assessed during surgery, and if necessary, reconstruction would be performed to correct nostril asymmetry through alar cartilage repositioning and cartilage suturing.
g) Correction of Nasal Tip Depression and Scar:
The collapsed nasal tip skin would be corrected with minimal damage. This would involve scar excision, reinforcement with dermis and cartilage, and careful suturing.
Stem cell injections were planned to aid in tissue healing and improve skin quality post-surgery.
5. Surgical Procedure
Based on the pre-surgical plan, the following procedures were performed:
a) Complete Septal Cartilage Reconstruction:
Due to severe inflammation, the donor rib cartilage from previous surgeries was not viable, and most of the septal cartilage had been destroyed.
Autologous rib cartilage was used to fully reconstruct the septum, providing the necessary structural support for the nose.
After septal reconstruction, the alar cartilages of the nasal tip were sutured
b) Reconstruction of Right-Side Septal Mucosa Deficiency:
It was found that the right side of the septal mucosa had been significantly damaged, likely due to previous cartilage removal and inflammation, leading to tissue necrosis.
Cartilage-perichondrium from the patient’s ear was harvested and used to reconstruct the weakened septal mucosa on the right side.
c) Removal of Remaining Gore-Tex:
Fragments of Gore-Tex material left in the nasal bridge, especially near the glabella, were completely removed.
d) Alar Cartilage Reconstruction:
Most of the alar cartilage had been lost, so autologous rib cartilage was used to reconstruct and reinforce the alar cartilage, helping to restore the symmetry and shape of the nostrils.
e) Revised Lateral Osteotomy:
A previous lateral osteotomy had been performed asymmetrically. To correct this, a delicate lateral osteotomy was performed to straighten the nasal bridge.
f) Correction of Nasal Tip Depression:
The collapsed nasal tip skin was preserved as much as possible while dermis and cartilage grafts were placed underneath to support the area and correct the depression.
Stem cell injections were administered to promote skin regeneration and enhance post-surgical healing.
6. Before and After Comparison
Upon reviewing the immediate post-surgery photos, the following improvements are evident:
Frontal view before surgery (left) after surgery (right)
Frontal View:
The columella has been naturally lowered, restoring a balanced look to the nose.
The previously wide and crooked nasal bridge has been corrected, appearing more natural and straight.
The significant skin depression at the nasal tip has been markedly improved, with noticeable correction of the collapsed skin.
Side profile view before surgery (left) after surgery (right)
Profile View:
The previously short nose has been elongated to a more proportionate length.
The low glabella (between the eyebrows) has been raised to a natural height, improving the profile's overall harmony.
The droopy, short nasal tip has been corrected, giving the nose a more refined and upright appearance.
The columella has been properly lowered, and the nasolabial angle has been corrected for a balanced transition between the nose and lips
45-degree angle view before surgery (left) after surgery (right)
Oblique View:
The previously short nose now appears balanced and in proportion with the rest of the face.
Nostrils before surgery (left) after surgery (right)
Nostril View:
The deep scar and collapse at the nasal tip have been greatly improved, with the depression now significantly reduced.
Although some redness remains, this is expected to fade over time, leading to a more natural appearance.
The nostril asymmetry has been significantly corrected, achieving a more balanced look.
7. Post-Surgery Photo Collection
Photos taken immediately after surgery, frontal view, 45-angle view, and side profile.
Photo of the nostrils
8. Final Evaluation
This case exemplifies the complexity and challenges involved in correcting a short nose with columellar and skin collapse due to severe inflammation. One of the most difficult aspects of the surgery was dealing with the severely damaged nasal tip skin, but through careful preservation of the skin, we were able to achieve a successful outcome.
The use of autologous rib cartilage for complete septal reconstruction, alar cartilage reconstruction, and delicate lateral osteotomy were key elements in restoring the nasal structure and aesthetics. The successful preservation and reconstruction of the collapsed nasal tip skin were the highlights of this surgery, as it not only resolved the functional issues but also contributed to a more natural result. While this approach increased the complexity of the surgery, it was essential for ensuring a long-lasting and natural outcome.
9. Closing Remarks
Surgery for short nose and contracted nose cases, particularly when accompanied by skin damage, can be extremely challenging. I believe that preserving the original skin and restoring it, rather than removing it, is the ideal approach whenever possible. In cases where it seems feasible to remove damaged skin, using techniques such as stem cell therapy and skin restoration yields more natural and satisfying results in the long term.
In this case, despite the option to remove some of the collapsed skin, we opted for a more cautious approach to preserve the skin and apply reconstructive techniques. This careful approach requires delicate handling and increases the complexity of the surgery, but it provides more natural and favorable long-term outcomes.
I hope this case gives hope to those dealing with contracted nose and skin damage, demonstrating that even in challenging cases, a well-planned and skillfully executed surgery can yield satisfactory results.
Rhinoplasty, especially when correcting a contracted nose, is not just about aesthetics—it also plays a critical role in restoring nasal function. Therefore, choosing a surgeon with extensive experience and expertise is crucial. At Nose Lab Clinic, we combine our ENT anatomical knowledge and rich surgical experience to create personalized surgical plans for each patient.
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.
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