Hello! This is Dr. Chayoung Kang, the Director of Noselab.
Today we will discuss the case of a patient who developed nasal contracture caused by inflammation after a surgery at another hospital.
Preoperative consultation
When seen from the front, this patient’s nose looked bent to the left side, and the nose bridge and nose tip looked overall wide. The nostril asymmetry was noticeable, and the nose tip was leaning to the left.
Frontal photo taken during the preoperative design consultation
The front view of the nose looked lifted even though the nose tip was droopy and short. It was found that the mouth also appeared to be protruding.
Side profile photo taken during the preoperative design consultation
When observing the nostril photo, we can definitely see the nose is tilted to the left side and there is a difference in the lenght of the nasal alar. The nostril asymmetry was visibly noticeable, and the right side of the columella was thick. Also, the upper side of the left alar looked thick, so we expected the possibility that the alar cartilage was damaged.
Nostril photo taken during the preoperative design consultation
Surgery Plan
For this patient’s surgery plan, we conducted stem cells treatment before the surgery due to this patient’s previous history of developing inflammation contracture deformity, and since the skin was small and thin, and could not be stretched. After observing the findings from the CT scan taken at our clinic and physical discovery, I suspected the alar and septal cartilage were seriously damaged, so I planned to reconstruct the alar and septal cartilage by using the self-rib cartilage. Considering the patient had previously suffered from inflammation, I decided to use the self-rib cartilage on the nasal bridge instead of using a silicone implant. To improve the frontal appearance that looked crooked and wide, I planned to remove the foreign substance and perform an osteotomy of the nasal bone altogether. Also, to improve the appearance of the nostrils that were visible from the front, we planned a nostril lowering surgery. We planned to use the self-rib cartilage instead of a silicone implant to increase the height of the nose bridge.
Surgical Findings
I approched the surgery carefully by referring to the contents of the surgery at the other hospital regarding suspicion of partial necrosis, and that the nose bridge kept getting swollen several times. The skin of the nose became very thin, and in the previous surgery, a broad piece of ear cartilage was forcefully transplanted into the nose tip, especially in the left side alar, the ear cartilage transplanted was thick and curved so it was poking out. There was definite evidence that the alar cartilage from both sides had been removed and could not be found, so I performed a reconstruction using the self-rib cartilage. The skin of the nose tip was thin and was almost impossible to stretch, so the height could not be increased much, which was disappointing, however I was able to improve the nostril asymmetry, their visibility, the visibly bending parts that were the parts that the patient did not like. We increase the height of the nose tip by reconstructing the septum into a sturdy structure. Therefore, we can wait enough time so we can increase the nose tip height a little more after 6 months post-surgery through stem cell therapy and additional cartilage transplant.
Before vs After Surgery
Seen from the front, the previosuly lifted appearance has been lowered effectively, and the amount of visible space in between the nasal alar and columella has been reduced. The nasal bridge was well connected, and looking natural.
In the 45-degree view photo, we can observe that the blunt nose bridge has become considerably slimmer.
From the frontal view, we can observe that the overall wide nose shape has become more natural-looking, and the visibility of the nostrils has improved a lot, and the nostrils look less bent and less asymmetrical.
The nostril asymmetry and the tilted part of the nose tip have significantly improved. Especially the left side of the alar that was tilted has improved a lot.
Photos After the Surgery
My opinion regarding nasal contracture
I will talk about my thoughts to this day regarding nasal contracture surgery since I have been performing many of them over the years. Nasal contracture surgery is a battle against inflammation at last, and it seems important to prevent deformation as much as possible after treatment for inflammation. In order to treat inflammation, the correct antibiotic should be used, and all artificial substances that were transplanted in the surgery must be completely removed.
Moreover, the prognosis was worse for people with small noses, as well as for people who got procedures such as alar or philtrum reduction if they developed nasal contracture. Therefore, I reached the conclusion that reducing the skin damage as much as possible, and stretching the skin more smoothly is an important part of the nasal contracture surgery. That is why, before the surgery we recommend and provide stem cell therapy to the patients who present nasal contracture.
Today we briefly discussed the surgery for nasal contracture. I hope this text will be helpful to those who are considering nasal contracture surgery, and are interested in a revision rhinoplasty.
Dr. Chayoung Kang
Director of Noselab Clinic
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