Cleft Lip and Palate Rhinoplasty Case in Korea_Structural Reconstruction Using Rib Cartilage

Cleft lip and palate rhinoplasty is a highly complex reconstructive nasal surgery performed to correct congenital asymmetry, nostril collapse, and structural deficiencies caused by cleft deformities.

This case from Nose Lab Clinic in Korea demonstrates how rib cartilage–based septal reconstruction, alar cartilage grafting, and nostril floor reinforcement achieved improved nasal symmetry, projection, and long-term structural stability through a closed rhinoplasty approach.

Author: Dr. Cha-Young Kang, Head Surgeon, Nose Lab Clinic

Published: October 18, 2024

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

Today, I would like to introduce a cleft lip and palate rhinoplasty case in Korea.

Patients with cleft lip and palate often present with congenital asymmetry and structural deficiency. While perfect symmetry is rarely achievable, meaningful improvement is possible through precise planning and structural reconstruction.

Pre-Surgery Consultation

The patient had a history of multiple previous cleft-related surgeries and presented with persistent nasal asymmetry and nostril collapse.

The patient previously underwent:

• Cleft lip closure

• Bone grafting

• Lip asymmetry correction

• Nasal reshaping using silicone and ear cartilage

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

Key Preoperative Concerns

Preoperative evaluation revealed nostril collapse, depressed columella, and skeletal deficiency contributing to severe asymmetry.

Key concerns included:

• Pinched appearance of the right nasal tip

• Depressed columella with crooked nasal tip

• Nostril asymmetry with right nostril collapse

• Nasolabial angle < 95°

• Right maxillary deficiency confirmed on CT

The patient requested:

• Correction of nostril asymmetry

• Improved nasal tip projection

• Restoration of balance

• A more harmonious nasal appearance

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

CT and 3D CT Analysis

CT imaging confirmed maxillary deficiency, septal deviation, and nasal floor height discrepancy contributing to asymmetry.

1.Facial CT Images (Original Images) , 2.Facial 3D CT Images (Original Images)

CT analysis demonstrated:

• Septal cartilage deviation (yellow line)

• Nasal floor height difference (red line)

• Planned rib cartilage reconstruction (blue area)

The autologous rib cartilage was used to:

• Reconstruct the septum

• Fill the depressed right nasal floor

• Restore a more symmetrical nasal base

CT scan images with colored lines showing septal cartilage deviation (yellow), nasal floor height difference (red), and rib cartilage graft reconstruction (blue) in a cleft lip and palate rhinoplasty case.

1.Image showing the depressed right maxillary floor, 2.Predicted reconstruction using autologous rib cartilage to fill the defect.

Surgical Procedure in Cleft Lip and Palate Rhinoplasty

The surgical strategy focused on restoring structural support and symmetry using autologous rib cartilage through a closed rhinoplasty approach.

Surgical Steps

a) Septal Cartilage Reconstruction

Autologous rib cartilage was used to reconstruct and stabilize the deviated septum.

b) Right Alar Cartilage Reconstruction

Rib cartilage grafting restored the missing alar support and corrected asymmetry.

c) Nostril Correction

A composite graft (cartilage-skin graft) reshaped the shortened right alar base.

d) Nostril Floor Reinforcement

Rib cartilage reinforced the depressed right nasal floor and maxillary defect.

All procedures were performed using a closed rhinoplasty technique, leaving no external scars.

Before and After Results

Postoperative comparison demonstrated improved symmetry, refined nasal tip projection, and balanced nasal base alignment.

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

Frontal View:

• Nostril asymmetry significantly improved

• Crooked nasal tip straightened

• Bulbous appearance refined

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

Profile View:

• Enhanced nasal tip projection

• Natural dorsal line created

• Nasolabial angle corrected to approximately 95°

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

Oblique View:

• More harmonious nasal bridge line

• Improved overall balance

Nostrils before surgery (left) after surgery (right)

Nostril View:

• Collapsed right nostril restored

• Columella straightened

• Reinforced nasal floor improved symmetry

Final Evaluation

Cleft lip and palate rhinoplasty requires structural reconstruction rather than simple soft-tissue adjustment due to congenital asymmetry and scar tissue.

This case demonstrates that:

• Septal reconstruction

• Alar cartilage grafting

• Nostril floor reinforcement using rib cartilage

• 
  

can achieve both functional improvement and aesthetic balance, even in complex cleft-related deformities.

While complete symmetry is limited by prior scarring and anatomy, significant enhancement in projection and harmony is achievable through a structural approach.

At Nose Lab Clinic, we prioritize long-term stability and reconstruction, not temporary reshaping.

Q. Why is cleft lip and palate rhinoplasty more complex than standard rhinoplasty?

A. Because congenital asymmetry, skeletal deficiency, and scar tissue require structural reconstruction rather than simple reshaping.

Q. Why is rib cartilage used in cleft rhinoplasty?

A. Rib cartilage provides strong, stable support for septal reconstruction, alar correction, and nostril floor reinforcement.

Q. Can perfect symmetry be achieved in cleft lip and palate rhinoplasty?

A. Complete symmetry is often limited, but significant improvement in balance, projection, and function is achievable.

Before and after comparison showing improved nasal symmetry following cleft lip and palate rhinoplasty.

Messenger(WhatsApp) : +82 1057360302

Home page : www.noselab.co.kr

Instagram : noselab_global

YouTube : Noselab

Email : noselab@naver.com