Nasal Contracture Reoperation Using Self-Rib Cartilage – Rhinoplasty Korea

noselab
2024년 7월 29일
4분 분량

최종 수정일: 10월 1일

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

Today, I will introduce a case of nasal contracture reoperation. The patient had undergone rhinoplasty with self-rib cartilage at another hospital, but inflammation developed within 7 days. Despite treatment, the cartilage had to be completely removed two weeks after surgery.

At Noselab, she first underwent three rounds of stem cell treatment with autologous fat to soften the hardened skin. After 6 months, we performed a general reconstructive surgery to address both functional and aesthetic problems, including nasal congestion.

Preoperative Design Consultation for Nasal Contracture Reoperation

These are photos before the stem cell treatment. From the frontal view, the most noticeable part at first sight is the nostril asymmetry and the nose width, and 4 months after the general removal, it was considered that the nose tip skin had become significantly hard and bumpy. Especially, the nostril asymmetry was severe and tissue that had appeared inside the enclosed areas became contractured, which made the right nostril smaller. Therefore, stem cells were extracted from autologous fat and injected in the nose tip as 3 rounds of stem cell treatment.

Photos taken prior to stem cell treatment, front view, 90-degree

Nostril photo in the design consultation before surgery.

Nasal Congestion Examination.

The patient had developed nasal congestion after the previous surgery, and found breathing through her mouth to be very uncomfortable, so we performed a simple endoscopy examination.

Through the CT scan taken at the clinic, the presence of septal deviation, hypertrophy of the inferior turbinates, and we confirmed the adhesion of the mucous membrane inside the nasal cavity through an endoscopy. The nasal endoscopy findings showed that the membrane on both sides of the septum and on the inferior turbinates presented multiple adhesions, so the cause for the nasal congestion is considered to be the septal deviation and the multiple adhesions in the nasal cavity.

Endoscopic photo of the nasal cavity mucous membrane adhesion

Surgical Plan

Outer osteotomy to improve the nasal bone asymmetry and the deviated nose bridge observed from the frontal view.
Reconstruction and binding of the the alar cartilage in order to correct the nostril asymmetry and the wide nose tip.
Lowering the columella so the ARC (alar-columellar relationship) becomes more natural-looking.

Nasal contracture reoperation – frontal design consultation photo showing nasal bridge starting point alignment

Frontal view

Aligning the starting point of the bridge to the pupil line, and heightening the nasal dorsum subtly using the self-rib cartilage.
Heightening the nose tip with the self-rib cartilage, in a manner that it does not look upturned, and slightly lowering the columella, correcting the nasolabial angle.

Side profile

To correct the nostril asymmetry, we planned to straighten the columella that was tilted to the right side, after using the self-rib cartilage to reconstruct the septal cartilage.
We planned to remove the thick scar tissue that was narrowing the inside of the right nostril, and advancing the mucous membrane through a dermis flap surgery to enlarge the nostril size. Especially, we plan to move the septum to the left side to adjust the proportion of the nostrils.

Nasal contracture reoperation – nostril design consultation photo

Nostril photo

To improve the patient’s nasal congestion, we plan to correct the septal curvature and peel the mucuous membrane adhesion.

Before and After Surgery Photos

Let’s compare the photos before and after the surgery.

Before surgery (left), After surgery (right)

From the lateral view, the parts where the nose tip appeared blunt and upturned were corrected significantly. The nasolabial angle became more natural-looking, and the parts that looked bumpy and flat in the nasal dorsum area looked higher as the bridge starting point became aligned to the pupil line.

In the 45-degree angle view, the areas which looked short and upturned have improved into a better looking appearance. Especially, the nostrils can be observed to be wider.

From the front, we can observe that the wide nose was corrected and that the appearance of the nostrils, that were excessively showing, has also been improved. The columella was lowered naturally, and the deviation was improved.

The most noticeable change at first sight is the asymmetry improvement of the nostrils. The scar tissue of the right nostril was removed and the width of the columella was reduced, as well as the columella was moved to the left side in order to correct the nostril asymmetry.

Surgical Table Photos

Overview

The nasal cartilage of the patient was in a worse condition than we had predicted before the surgery. Since from the previous surgery, about 80% of the septal cartilage and the right side of the alar cartilage had disappeared, and this cartilage had to be completely reconstructed using the self-rib cartilage. Cartilage reconstructive surgery may not show much effect at first, but I think it plays a big role in maintaining the shape and preventing deformation over time. Of course, because of the reconstructive surgery, the asymmetry may seem worse at first, but I think it would be good to think of it as swelling related to the recovery.

This patient had a revision surgery due to deformity caused by inflammation, so autologous costal cartilage was used for both the bridge and tip of the nose. We need to focus on preventing postoperative infection and ensuring a safe recovery. Therefore, we plan to actively help the wound heal by administering antibiotics, hyperbaric oxygen therapy, and laser therapy.

Today, we talked about surgery for nasal contracture. I hope it can be of help to those people who are having a hard time due to nasal contracture

Noselab Rhinoplasty Clinic

Dr. Chayoung Kang