Nasal Contracture Reconstructive Surgery with Rib Cartilage in Korea
- Dr. Chayoung Kang
- 2024년 7월 8일
- 6분 분량
최종 수정일: 5월 12일
This case reviews nasal contracture reconstructive surgery in Korea for a patient with severe inflammatory nasal deformity, partial nasal tip necrosis, scar contracture, nostril asymmetry, and structural support loss after multiple previous rhinoplasty procedures. Reconstruction focused on contracture release, autologous rib cartilage support, nostril correction, and restoration of nasal stability.
Author: Dr. Cha-Young Kang
Clinic: NoseLab Clinic
Published: 2024
Last Updated: 2026
Introduction
Hello, this is Dr. Cha-Young Kang of NoseLab Clinic.
This case involves nasal contracture reconstructive surgery in a patient who developed severe nasal deformity after repeated inflammation, partial nasal tip necrosis, tissue loss, and scar contracture. The patient had undergone eight previous rhinoplasty surgeries, making this her ninth revision surgery.
The surgery was performed using a closed rhinoplasty / endonasal approach with autologous rib cartilage reconstruction. The goal was to release contracted tissue, rebuild lost structural support, improve nostril symmetry, and restore a more stable nasal framework.
Clinical Background – Nasal Contracture After Severe Inflammation
The patient developed nasal contracture after repeated inflammation and partial necrosis of the nasal tip. Over time, inflammation and tissue injury led to scarring, tissue stiffness, and progressive nasal
In severe nasal contracture, the problem is not limited to external shape. The nasal skin, soft tissue, cartilage support, nostril shape, and airway space may all be affected by scar contracture.
Main Background Factors
The key background factors included:
Repeated inflammation after previous rhinoplasty procedures
Partial necrosis of the nasal tip
Eight previous nasal surgeries
Scar contracture and tissue stiffness
Loss of normal cartilage support
Progressive nasal asymmetry and deformity
Because this was a ninth revision surgery, the surgical plan had to account for limited tissue flexibility, scarred soft tissue, and weakened structural support.
Preoperative Design and Analysis
Preoperative evaluation was performed using frontal, side profile, and nostril base views. The analysis showed severe deformity involving the nasal tip, nostrils, columella, and nasal framework.
Frontal View Analysis
The frontal view showed excessive nostril exposure, rightward deviation of the nasal tip, and visible scarring from previous inflammation.
The main frontal findings included:
Excessive nostril show
Nasal tip deviation to the right
Scar tissue on the left nasal tip
Widened nasal appearance
Frontal asymmetry
Side Profile Analysis
The side profile showed a complex deformity in which the nasal tip appeared both droopy and upturned. The nasolabial angle was widened, and a mild dorsal hump was also present.
The main side profile findings included:
Droopy but upturned nasal tip
Wide nasolabial angle
Mild dorsal hump
Imbalanced nasal projection
Unstable nasal tip support
Nostril View Analysis
The nostril view showed significant nostril asymmetry. The left nostril was smaller due to columellar adhesion and scar contracture.
The main nostril findings included:
Smaller left nostril
Columellar adhesion to the alar tissue
Nostril asymmetry
Partial airway obstruction
Contracture-related distortion of the nasal base
These findings confirmed that this case required reconstructive surgery rather than simple cosmetic revision.
Surgical Plan for Nasal Contracture Reconstructive Surgery
The surgical plan focused on releasing contracture, reconstructing lost cartilage, restoring nostril symmetry, and rebuilding nasal support using autologous rib cartilage.
Contracture Release
Scar contracture was released to reduce tissue pulling and allow repositioning of the nasal tip and nostril structures. In revision cases with partial necrosis and scar tissue, contracture release must be performed carefully to avoid additional tissue injury.
Outer Osteotomy for Crooked Nasal Bones
Outer osteotomy was planned to correct crooked nasal bones and improve frontal alignment. This helped address the widened and deviated appearance of the nasal framework.
Septal Reconstruction with Autologous Rib Cartilage
Autologous rib cartilage was used to reconstruct the septal support structure. Rib cartilage was selected because the patient had severe structural weakness after multiple previous surgeries.
Rib Cartilage Grafting for Nasal Tip and Bridge
Rib cartilage grafts were used for both nasal tip and bridge reconstruction. The purpose was to rebuild stable support and restore nasal contour after tissue loss and scar-related deformity.
Septal Extension Graft for Upturned Tip Correction
A septal extension graft was used to correct the upturned nasal tip and improve tip stability. This helped reposition the nasal tip while reducing the contracted appearance.
Bilateral Alar Cartilage Reconstruction
Both alar cartilages were reconstructed to lower and stabilize the nostril margins. This step was important for reducing excessive nostril show and improving nostril symmetry.
Local Flap Surgery for Left Nostril Widening
Local flap surgery was considered to widen the smaller left nostril if needed. This was planned because the left nostril was narrowed by columellar adhesion and scar contracture.
Skin Stretching and Dermal Grafting
Skin stretching procedures were used for contracted dorsal skin. A dermal graft was also planned under the sunken scar tissue on the left nasal tip to improve soft tissue coverage and surface contour.
Before and After Surgery Results
Side View
From the side view, the droopy and upturned nasal tip deformity was improved. The nasolabial angle was reduced, and the nasal contour appeared more stable.
Oblique View
The oblique view showed improved facial balance and a smoother nasal contour. The protrusive appearance around the mouth area appeared less prominent after nasal support was restored.
Frontal View
From the frontal view, excessive nostril show was reduced, and nasal symmetry improved. The nasal tip appeared more centered, and the overall nasal shape became more balanced.
Nostril View
The nostril view showed marked improvement in nostril asymmetry. The left nostril appeared more open after release of columellar adhesion and reconstruction of the nasal base.
Functional Outcome
Partial airway obstruction improved after structural reconstruction and nostril correction. Restoring nasal support and reducing adhesion helped improve the functional nasal airway.
Postoperative Appearance
Postoperative photos showed improved nasal projection, frontal symmetry, and nostril balance across multiple angles. The reconstructed nasal framework appeared more stable after contracture release and rib cartilage support.
Because the patient had severe preoperative contracture, repeated inflammation, and partial tissue necrosis, the result should be understood as reconstructive improvement within complex tissue limitations.
General Overview – Understanding Nasal Contracture
Nasal contracture occurs when severe or repeated inflammation damages cartilage and soft tissue. As healing progresses, normal tissue may be replaced by rigid scar tissue, leading to nasal shortening, asymmetry, nostril distortion, and progressive deformity.
Key Principles in Managing Nasal Contracture
Important principles include:
Active inflammation must be controlled before reconstruction
Rapidly progressing deformity may suggest ongoing inflammation
Tissue recovery before surgery can be important for safer reconstruction
Autologous tissue is often preferred in severe reconstructive rhinoplasty
Structural stability is essential to reduce recurrence of deformity
Reconstructive Principles in Severe Nasal Contracture
Autologous rib cartilage provides reliable structural support in advanced nasal contracture reconstruction. It can be used for septal reconstruction, nasal tip support, bridge support, and correction of complex deformity.
In severe revision cases, the priority is not simply making the nose look higher or sharper. The main goal is to rebuild a stable framework, reduce contracture forces, improve symmetry, and restore functional support.
Why Rib Cartilage Was Used
Rib cartilage was appropriate in this case because the patient had severe cartilage loss, scar contracture, and multiple previous surgeries. A stronger graft material was needed to support the nasal tip, bridge, and septal framework.
Surgeon’s Commentary
This was a complex case of nasal contracture reconstructive surgery involving repeated inflammation, partial nasal tip necrosis, scar contracture, nostril asymmetry, and eight previous failed rhinoplasty procedures.
The key to surgery was controlling the contracture forces and rebuilding the structural foundation of the nose. In this type of case, cartilage grafting alone is not enough; scar release, soft tissue management, nostril correction, and airway restoration must be planned together.
Autologous rib cartilage was used because it provided the strength needed for a ninth revision surgery with significant structural compromise. Bilateral alar cartilage reconstruction and release of columellar adhesion were also important for correcting nostril show and asymmetry.
This case demonstrates that severe nasal contracture after inflammation and necrosis should be approached as reconstructive surgery. The goal is to restore stability, symmetry, and function while respecting the limitations of scarred and previously damaged tissue.
FAQ
Why does nasal contracture occur after inflammation?
Nasal contracture can occur when inflammation damages cartilage and soft tissue. During healing, scar tissue may form and pull the nose into a shortened, distorted, or asymmetrical shape.
Why is rib cartilage used in nasal contracture reconstructive surgery?
Rib cartilage is often used when the nasal framework is severely weakened or previously damaged. It can provide strong support for septal reconstruction, nasal tip correction, and bridge reconstruction.
Can nostril asymmetry improve after nasal contracture reconstruction?
Nostril asymmetry can improve when scar adhesion is released and alar cartilage support is reconstructed. The degree of improvement depends on tissue condition, previous surgeries, and the severity of contracture.
Is nasal contracture reconstruction different from standard revision rhinoplasty?
Yes. Nasal contracture reconstruction often requires scar release, cartilage rebuilding, soft tissue management, and airway correction. It is more complex than revision rhinoplasty performed only for shape adjustment.
International Consultation
For international patients, a photo-based consultation may help clarify whether nasal contracture reconstructive surgery, rib cartilage reconstruction, nostril correction, or functional correction may be needed.
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