Correction of Nasal Skin Necrosis and Nostril Asymmetry: A Complex Reconstructive Case

Hello, this is Dr. Cha-Young Kang, Medical Director at NoseLab Clinic.

Today, I’d like to share a complex case involving a patient who underwent nasal reconstruction to address previous complications, including skin necrosis on the nasal dorsum and multiple structural issues following a long history of nasal surgeries.

Design Consultation: Frontal View, Left Side View, and Oblique Side View Photos

Design Consultation: Right Oblique Side View, Side View, and Nostril View Photos

📍 Surgical History

• 15 years ago: Silicone implant rhinoplasty

• 10 years ago: Removal of implant, ear cartilage grafting, and alar base reduction

• 9 years ago: Repeated ear cartilage grafting, followed by infection and removal of grafts

• Subsequently: AlloDerm used for nasal bridge; gluteal dermis graft for nasal tip

• Multiple resurfacing procedures (chemical peels, etc.) led to significant skin thinning

• 5 years ago: Autologous rib cartilage and dermis graft

• 6–7 years ago: Upper lip lift and double jaw surgery

🔎 Initial Presentation

• Residual deformity and thinning due to prior skin necrosis of the nasal dorsum

• Loss of dermal tissue and subsequent irregular scarring

• Redness and vascular compromise of nasal tip

• Pronounced asymmetry in alar base height

• Unusual nostril shape (inverted “^ ^” configuration)

• Overall ptosis of the alar rims

• Dense scar tissue in the nasal tip due to repeated surgeries

• History of multiple implant materials and grafts

✨ Patient Goals

• Smooth out the irregular contour of the nasal bridge

• Improve symmetry of the alar bases

• Correct the nostril shape and alar ptosis

• Restore overall balance and natural appearance

💉 Surgical Plan and Procedures

Structural Restoration:

• Extended the nasal septum using autologous cartilage

• Corrected dorsal depression with rib cartilage graft

• Preserved vascularized tissue using a conservative dissection approach

• Applied concentrated growth factors to promote vascular recovery

• Repositioned the alar rims for nostril shape correction

• Refined the nasolabial angle for better facial harmony

Aesthetic Refinement:

• Smoothed and leveled the nasal dorsum

• Adjusted alar base height for symmetry

• Elevated drooping alar rims

• Achieved natural nostril configuration

Functional Corrections:

• Septoplasty and turbinate reduction performed to improve nasal airflow

✅ Surgical Outcomes

Before (Left) / Immediately After (Right)

Frontal View:

• Noticeable improvement in nasal bridge smoothness

• Balanced alar base heights

• Harmonious nostril shape

• Improved overall facial symmetry

Before (Left) / Immediately After (Right)

Side Profile:

• Significantly reduced irregularities of the nasal dorsum

• Well-proportioned nasal projection and length

• Improved nasolabial angle

• Harmonized upper lip and columellar projection

Before (Left) / Immediately After (Right)

Nostril View:

• More symmetrical nostril shape

• Elevated and repositioned alar rims

• Corrected “^ ^” nostril appearance

• Stable and functional nasal base

Before (Left) / Immediately After (Right)

👨‍⚕️ Surgeon’s Commentary

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

Immediately After Surgery: Nostril View Photo

This was a particularly complex case, involving over 15 years of prior surgeries and grafts, culminating in skin necrosis and vascular compromise. Intraoperatively, blanching of the nasal skin confirmed compromised blood supply. Careful handling and tissue-preserving techniques were critical.

The patient’s skin had thinned extensively due to repeated grafting and resurfacing procedures, leading to a highly vulnerable nasal dorsum and fragile vascular network. This necessitated gentle dissection, autologous cartilage grafting, and adjunctive treatment with concentrated growth factors to enhance soft tissue regeneration.

Additionally, asymmetry in the alar bases and unique nostril shape were corrected through precise repositioning of the alar cartilages. Septal deviation and turbinate hypertrophy were also addressed to optimize both structure and function.

This case exemplifies the importance of a highly individualized approach to complex nasal reconstruction—balancing aesthetic refinement with functional recovery for long-term satisfaction.

Thank you for reading.

— Dr. Cha-Young Kang, Medical Director at NoseLab Clinic

https://blog.naver.com/cykang/223870284280