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Closed rhinoplasty_Korea Deviated nose + upturned nose + nostril asymmetry correction revision rhinoplasty(Alar rim lengthening + donated rib cartilage)

This patient visited our clinic for a curved nose correction with showing asymmetric nostrils too much. I planned to lower the position of the tip of the nose in the preoperative design, hold the starting point of the nose with the pupil line, and correct the position of the silicone implant straightly.

I planned to lower the nose tip position to improve the feeling that the nose tip seems to be upturned. There was a foreign body (filler) in the glabellar area, so it was spread out a lot, and the impant was curved, so the nose looked curved overall.

The most serious problem was nostril asymmetry, the nose tip was tilted to the left, and the septal reconstruction and septoplasty was planned due to suspected septal cartilage damage. The cause of nostril asymmetry was judged to have been caused by the bent tip of the nose, so it could be expected that it would improve a lot by correcting the position of the tip of the nose straightly.

surgical findings

I found that 7 to 8mm of the front part of septal cartilage was resected from other clinic and used as a cosmetic material for the tip of the nose, which weakened the tip of the nose, causing the tip of the nose to the left, resulting in the asymmetry of the nose. Therefore, the front part of the septal cartilage was reconstructed using the donated rib cartilage and the previously used septal cartilage. The right nostril was more upturned, so I performed by reinforcing the right alar cartilage using the ear cartilage previously implanted at the end of the nose.

The blunt feeling of the tip of the nose has improved a lot, and the columella was lowered unnecessarily, slightly reduced to make the shape of the tip of the nose more natural.

The parts that looked bent from the front were improved through cartilage reinforcement and the removal of foreign materials(filler) from the glabella area, and the existing silicon impant was also replaced with new one. We could observe a lot of improvement immediately after surgery.

The most important part of this surgery was nostril asymmetry, but I explained before the operation that there was a difference in the size of the nostril due to asymmetric alar reduction at the previous clinic, and I did my best to match the size and shape of the nostril as much as possible by correcting the shape of the columella rather than the alar.

It's showing a lot of improvement right after the surgery. I think she need to pay attention to wound management and trauma prediction so that it doesn't deform as you recover.

A general review

Compared to the number of surgeries, cartilage damage was severe. The bent nose correction was difficult due to asymmetry caused by excessive alar reduction. But the surgery went well as planned.

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