Nasal Contracture Reconstructive Surgery with Rib Cartilage – Rhinoplasty Korea

noselab
2024년 7월 8일
3분 분량

최종 수정일: 10월 1일

Hello!

I am Dr. Chayoung Kang, Director of Noselab Rhinoplasty Clinic.

Today, I will present a case of nasal contracture reconstructive surgery for a patient who suffered repeated inflammation and partial necrosis of the nose tip. This was her 9th revision rhinoplasty after 8 previous failed surgeries.

Photo of the partial necrosis at the nose tip due to severe inflammation.

Preoperative Design for Nasal Contracture Reconstructive Surgery

Frontal view before nasal contracture reconstructive surgery, showing nostril asymmetry, droopy tip, and scar from inflammation.

Frontal view before surgery.

From the front, the nostrils were too visible and the nose tip looked deviated to the right side. As the nostrils are excessively exposed, the asymmetry is more visible.

The nose is overall wide and the scar due to past inflammation can be observed on the left side of the nose tip.

Side profile before surgery.

Seen from the side, there is a slight nose hump and, while the nose tip is droopy, it is also upturned which makes the columella seem to have a wide nasolabial angle.

Nostril view before nasal contracture reconstructive surgery, showing asymmetry with smaller left nostril and columella adhesion

Nostrils before the surgery.

When observing the nostril photo, the left nostril is small compared to the right nostril. The columella seems to be adhered to the lateral alar seemingly blocking the upper part of the nostril.

Surgical Plan for Nasal Contracture after Inflammation

Correcting the crooked nasal bone areas through an outer osteotomy.
It was planned to usee self-rib cartilage in both nose tip and nose bridge.
We planned to a septal reconstruction using self-rib cartilage to correct the upturned nose and nostril asymmetry.
To correct the upturned nose, we planned to perform a septal extension graft, and alar cartilage reconstruction on both sides to lower the nostrils.
Local flap surgery was planned as needed to widen the left nostril.
It was predicted that the skin would not be able to be stretched well due to the nasal contracture, we planned a surgery to stretch the skin on the nasal bridge.
A dermal graft was planned under the sunken skin on the left side.

Before vs. After surgery

Let’s compare the photos before and after surgery.

Before surgery (left), after surgery (right)

When observing the side profile photos, we can see that the droopy nose tip was corrected and that the nasolabial angle was reduced, as well as the nose shape also became more natural-looking.

In the oblique side profile, the improvement of the nasolabial angle gave an improved effect to the protruding mouth.

The parts where the nostrils were too visible when seen from the frontal view were improved.

The nostril asymmetry was improved a lot.

Photos taken after surgery

Photos after surgery, frontal view, 45-degree angle, and 90-degree angle.

General Overview

Today, we looked at surgery to repair the contracture deformity caused by severe inflammation that had occurred multiple times. When you suffer from severe inflammation, damage to normal tissue is inevitable. The inflammation causes the nose tip cartilage to melt away, and the soft tissues change into hard contracture tissues and shrink, causing the nose to become smaller and distorted, which ultimately causes contracture deformity.

In this type of nose surgery, the first thing to check and treat is inflammation. In other words, if the deformity is progressing rapidly, there is a high possibility that inflammation still remains, so inflammation treatment should be actively performed. And after the inflammation is controlled, it is very important to sufficiently perform stem cell treatment before the surgery to restore damaged skin tissue to be able to create a good final shape.

And the surgery is safest when it using autologous tissue as much as possible. In particular, it is safe to use autologous costal cartilage for the tip of the nose, and autologous costal cartilage or silicone implants can be considered for the bridge of the nose.

Today we talked about surgery for nasal contracture. I hope this text is of help to those who are concerned regarding nasal contracture.

Dr. Chayoung Kang

Director of Noselab Clinic