Nasal Contracture Reconstructive Surgery with Rib Cartilage – Revision Rhinoplasty in Korea for Severe Inflammatory Deformity

noselab
2024년 7월 8일
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Nasal contracture reconstructive surgery is a complex revision rhinoplasty performed to correct nasal deformity caused by repeated inflammation, tissue loss, and scar contracture.

This case from NoseLab Clinic in Korea demonstrates how rib cartilage–based reconstructive rhinoplasty restored nasal structure, symmetry, and function in a patient undergoing a 9th revision surgery after severe inflammation and partial necrosis.

Author: Dr. Cha-Young Kang, Director, NoseLab Rhinoplasty Clinic

Published: July 8, 2024

Hello, I am Dr. Cha-Young Kang, Director of NoseLab Rhinoplasty Clinic.

Today, I will present a challenging case of nasal contracture reconstructive surgery.

The patient suffered from repeated inflammation and partial necrosis of the nasal tip and had undergone eight previous failed rhinoplasty surgeries, making this her ninth revision surgery.

Clinical Background – Nasal Contracture after Severe Inflammation

The patient developed nasal contracture due to repeated inflammation, tissue necrosis, and scarring, resulting in progressive nasal deformity and asymmetry.

Preoperative nasal base views showing partial nasal tip necrosis caused by severe inflammation in a nasal contracture reconstructive surgery case. — Photo of the partial necrosis at the nose tip due to severe inflammation.

Preoperative Design and Analysis

Frontal View Analysis

The frontal view revealed excessive nostril show, rightward deviation of the nasal tip, and visible scarring from previous inflammation.

Excessive nostril exposure
Tip deviation to the right
Scar tissue on the left nasal tip
Overall widened nasal shape

Preoperative frontal view showing nasal asymmetry and contracture deformity before nasal contracture reconstructive surgery. — Frontal view before surgery.

Side Profile Analysis

The side profile showed a droopy yet paradoxically upturned nasal tip with a widened nasolabial angle and slight dorsal hump.

Droopy but upturned nasal tip
Wide nasolabial angle
Mild dorsal hump

Side profile before surgery.

Nostril (Base) View Analysis

The nostril view demonstrated significant asymmetry, with a smaller left nostril caused by columellar adhesion and scar contracture.

Smaller left nostril
Columella adhesion to alar tissue
Partial airway obstruction

Preoperative nasal base view showing nostril asymmetry and columellar adhesion caused by nasal contracture before reconstructive rhinoplasty. — Nostrils before the surgery.

Surgical Plan for Nasal Contracture Reconstructive Surgery Using Rib Cartilage

The surgical plan focused on releasing contracture, reconstructing lost cartilage, restoring symmetry, and re-establishing nasal support using autologous rib cartilage.

Surgical Strategy Included

Outer osteotomy to correct crooked nasal bones
Septal reconstruction using autologous rib cartilage
Rib cartilage grafts for both nasal tip and bridge
Septal extension graft to correct upturned tip
Bilateral alar cartilage reconstruction to lower nostrils
Local flap surgery to widen the left nostril if required
Skin stretching procedures for contracted dorsal skin
Dermal graft under sunken scar tissue on the left nasal tip

Before vs. After Surgery Results

Postoperative comparison showed significant improvement in nasal shape, symmetry, and nasolabial angle despite severe preoperative contracture.

Before surgery (left), after surgery (right)

Droopy nasal tip corrected
Reduced nasolabial angle
More natural nasal contour

Before surgery (left), after surgery (right)

Improved facial balance
Reduced protrusive appearance of the mouth

Frontal view comparison before and after nasal contracture reconstructive surgery showing improved nasal symmetry, reduced nostril show, and restored midline alignment. — Before surgery (left), after surgery (right)

Reduced excessive nostril show
Improved frontal symmetry

Nasal base view comparison before and after nasal contracture reconstructive surgery showing improved nostril symmetry, released columellar adhesion, and restored nasal opening. — Before surgery (left), after surgery (right)

Marked improvement in nostril asymmetry
Release of columellar adhesion

Postoperative Appearance

Postoperative photos demonstrated stable nasal shape with improved projection and symmetry across all angles.

Postoperative views showing the frontal, 45-degree, and side profiles after nasal contracture reconstructive surgery, demonstrating restored nasal contour, symmetry, and stable tip support. — Photos after surgery, frontal view, 45-degree angle, and 90-degree angle.

General Overview – Understanding Nasal Contracture

Nasal contracture occurs when severe or repeated inflammation destroys normal cartilage and soft tissue, which then transforms into rigid scar tissue and causes progressive nasal shrinkage and deformity.

Key points in managing nasal contracture:

Active inflammation must be fully controlled before surgery
Rapidly progressing deformity often indicates ongoing inflammation
Preoperative tissue recovery, including regenerative or stem-cell-based treatments, is critical for safe reconstruction
Autologous tissue is safest for reconstructive rhinoplasty

Reconstructive Principles in Severe Nasal Contracture

Autologous rib cartilage provides the most reliable structural support in advanced nasal contracture reconstruction.

Rib cartilage is ideal for nasal tip reconstruction
Rib cartilage or silicone implants may be considered for nasal bridge support
Structural stability is essential to prevent recurrence of deformity

Final Thoughts on Nasal Contracture Reconstructive Surgery

Successful correction of nasal contracture requires precise control of inflammation, extensive structural reconstruction, and the use of reliable autologous tissue.

This case demonstrates that even in advanced contracture following multiple failed surgeries, reconstructive rhinoplasty using rib cartilage can restore both form and function when performed with a comprehensive and cautious approach.