Hello, this is Dr. Chayoung Kang, Director of Noselab Rhinoplasty Clinic. Today, we will introduce the rhinoplasty case of a patient who had undergone 6 rhinoplasty surgeries in the span of 27 years, and who ultimately visited our clinic to correct a contractured nose deformity.
This case is an example that demonstrates the importance and complexity of revision rhinoplasty.
Preoperative Design Consultation and Patient's Medical History
The patient underwent their first rhinoplasty 27 years prior, and went through 6 surgeries more after. The patient's medical history is as follows:
27 years prior: L-shaped silicone implant insertion
24 years prior: L-shaped silicone implant insertion and nostril reduction surgery (increased asymmetry)
10 years prior: Autologous rib cartilage, ear cartilage, osteotomy, silicone implant (an edge formed on the nasal dorsum)
1 year prior: Autologous rib cartilage, septal cartilage, silicone implant (nose height increase, worsening asymmetry)
2 post-op: complete implant removal, only tied cartilage remained.
4 months prior: ear cartilage transplant, non-prosthetic rhinoplasty, philtrum reduction surgery.
The following are the patient's requirements for the surgery:
Lifting the columella and improving the philtrum that appears long.
No demands regarding the nose height increase.
Confirm whether if it is possible to improve the asymmetrical nasal alar.
A softer nose shape, but not pointy.
It is worth noting that, due to the previous nostril reduction surgery, the nostril lenght had been excessively shortened.
Preoperative Analysis
Frontal view:
Nose tip tilted to the left side
Noticeable nostril asymmetry
Wide and blunt nose tip
Overall wide nasal bridge
Side profile view:
Droopy nose tip
Slight nasal hump
Retracted columella and mouth protrusion
45-degree view:
Droopy and long nose tip
Visible nasal contracture appearance
Nostril view:
Prominent nostril asymmetry
Pinched-looking nostrils
Columella tilted to the left side
Additionally, the CT findings showed the septal cartilage was leaning to the left side, the nasal endoscopy test also confirmed that the left intranasal cavity was narrow. Therefore, we were able to diagnose septal deviation.
Surgical Plan
After determining the unsatisfactory parts of the patient’s condition, we came up with the following plan:
Stem cell treatment, 3 sessions as nasal contracture treatment.
Septal reconstruction (depending on the patient's condition)
Lateral osteotomy to correct the nasal deviation.
Nostril lowering surgery to correct the nostril asymmetry.
Septal extension graft.
Before and After Surgery Photos
Straightening and correction of the bent nose tip.
Visible improvement of the nostril asymmetry.
Changed the blunt and wide nose tip to a more refined appearance.
Slimming of the wide nasal bridge.
General balance enhancement by adjusting and raising the droopy nose tip.
Aleviated the nasal hump appearance.
Corrected the retracted columella and improved the mouth protrusion.
Nose tip lenght and height correction.
Improved appearance of the contractured nose into a softer contour.
Definite nostril asymmetry improvement.
Transformed the pinched nostrils to a more natural shape.
Centered the left-side tilted columella.
Overview
This case illustrates the complex problems that can arise after multiple rhinoplasty surgeries, particularly the difficulty and importance of correcting a contractured nose.
The biggest challenge was to reconstruct the cartilage structures that had been severely damaged by previous surgeries. The septum, alar cartilage, and the superior lateral cartilage all had to be reconstructed, a task that required a high level of skill and experience.
In addition, because the length of the nasal alar was excessively short due to the previous nostril reduction surgery, there was a limit to raising the tip of the nose. This reminds us once again of the relevance of the previous surgeries and the need for careful planning accordingly.
Stem cell therapy as a treatment for the nasal contracture deformity helped improve the condition of the tissue before surgery, which is thought to have contributed to increasing the success rate of the surgery and shortening the recovery period.
Treatment for septal deviation was also performed, which resulted in not only cosmetic improvements but also functional improvements. This is where my expertise as an otolaryngologist shined.
I hope this case will give hope to those who are concerned about unsatisfactory results after multiple rhinoplasty surgeries. Although the correction of a contractured nose is a very complex and difficult surgery, satisfactory results can be achieved through proper surgical planning and techniques.
Especially in the case of such complex reoperations, the selection of a doctor with extensive experience and skills is essential. Based on the anatomical knowledge and abundant surgical experience of an otolaryngologist, Noselab provides an optimized surgical plan for each patient.
Those considering rhinoplasty, especially those considering reoperation, should make a decision after careful consideration and sufficient consultation.
With Noselab Clinic you can achieve a beautiful and healthy nose!
After Surgery Table Photos
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