Hello, I am Dr. Chayoung Kang, the Director of Noselab Clinic.
Today I would like to talk about a slightly complicated surgery. It’s not a very difficult surgery, I would rather say it is an unfortunate case? I will tell you about a case where a philtrum reduction surgery or nostril reduction surgery directly affect the shape of the nose.
Personally, I find this very upsetting. I feel like these surgeries have blown away the opportunity for improvement.
Preoperative Design Consultation
This patient had undergone surgery four times before coming to our hospital. They had used autologous dermis from the hip on the bridge of the nose, and underwent various surgeries, including philtrum reduction and even a nasal bone osteotomy . The patient came to the hospital because they wanted to correct the nasal asymmetry, which made it look crooked, flat and slanted.
Frontal view before surgery
In the frontal photo taken before surgery, the asymmetry of the nasal alar is noticeable and appears significant. Also, the alar of the nose appears crooked, as well as the tip of the nose.
Side profile view before surgery
When viewed from the side, the bridge of the nose is high compared to the tip of the nose, which is short and droopy, and the border between the tip and bridge of the nose appears depressed.
The nostril asymmetry is severe, and the bottom of the right nose appears much shorter than the left.
Surgical plan
According to the CT scan of the nasal region taken at the time of visiting the hospital, both nasal bones had collapsed due to foreceful nasal bone osteotomy, which made the nasal roof area very narrow. Both sides of the nasal bridge implant were pressed from the front, giving a strong chalk-like sensation, so external osteotomy restoration surgery was planned.
We plan to remove the autologous dermis and reuse it on the tip of the nose.
We plan to reallocate the cartilage at the tip of the nose and reinforce the alar cartilage using autologous costal cartilage to improve the pinched appearance.
Because of the forceful philtrum reduction surgery, it was expected that there would be a significant discrepancy in the width of the bottom of the nose, so rotation flap surgery was planned to expand the insufficient skin below the right side of the columella.
Surgical findings
After removing the autologous dermis and checking the condition of the nasal bone, most of the roof of the nasal bone was missing and there was not much nasal bone left, so the remaining nasal bones on both sides were moved to the outside and the space between the nasal bones was filled using autologous costal cartilage and covered widely with silicone implants. The autologous dermis on the bridge of the nose, along with the ear cartilage used in the front, was completely removed in a circular shape and reused to reinforce the thin skin at the tip of the nose.
Photo of the removed ear cartilage (left) and the autologous dermis (right)
The most difficult part of today’s surgery was improving the nostril asymmetry caused by philtrum reduction surgery performed at another hospital. In order to reduce the philtrum, the columella must be separated from the philtrum, then the philtrum must be cut sufficiently and sutured again in the exact center, but in this patient, the columella was attached to the bottom of the right side of the philtrum, as shown in the photo, so the width of the bottom of the right nose is absurd and excessive compared to the left. To improve this area, rotational flap surgery was performed to move the skin inside the nostrils outward to widen the bottom of the nose.
This is a case of incorrect suturing in the previous philtrum reduction surgery.
Before and After surgery photos
Let’s compare the before and after surgery photos.
When observing the side profile view of the photo taken after the surgery, we can tell that the previously droopy nose tip has now been corrected and the nasolabial angle became more natural-looking.
If you look at a 45-degree side photo, you can see that the starting point between the eyebrows has gone down and the tip of the nose has become more prominent.
When viewed from the front, you can see bruises on the bridge of the nose caused by removing autologous dermis, but they are not deep bruises and most will completely disappear within 3 weeks. The areas where the bottom of the nose was very different and the areas where it looked crooked have improved significantly.
Looking at the nostril, the severely narrowed right nostril has recovered to some extent, but it may shrink by about 10% during the recovery process. However, since part of the skin inside the nostril is brought forward to expand the space, it is expected that the widened nostril will not narrow much.
Photos after surgery
Dr. Kang’s opinion regarding the relation between philtrum reduction surgery and rhinoplasty
First of all, my thoughts on philtrum reduction surgery and rhinoplasty surgery are strictly my personal thoughts, so please do not misunderstand. I have been doing rhinoplasty surgery for a long time, so there are two surgeries that I personally dislike. They are the nose reduction surgery and the philtrum reduction surgery. Since I perform closed rhinoplasty sutgery, there may be more sensitive areas in the nostril area where the nostrils are reduced, but I do not like these surgeries because there are often cases in which it is not possible to create a better shape.
And just by looking at the scar, it is on an anatomical part where having a scar is not good. No matter how well you suture it, the scar cannot remain good because it is an area that has to be constantly pulled while talking, eating, laughing, crying, and making facial expressions. And since everyone has big or small asymmetries, if you separate and reattach the nasal wings and columella, the asymmetry will inevitably become worse. Like this patient today, the previous surgeon may not have intentionally placed the columella on the right side of the philtrum, but as a result, it was incorrectly placed more than 2 millimeters to the right, causing a curved nose tip and nostril asymmetry.
So, in my opinion, I think it would be a good idea to be very careful when deciding on nose reduction or philtrum reduction surgery and, even if you do undergo surgery, to have surgery with minimal incisions.
Today we talked about rhinoplasty for a patient who had gotten a philtrum reduction surgery. I hope this text is of help for those who are concerned with this topic.
Dr. Chayoung Kang
Director of Noselab Clinic
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