Nasal Septum Reconstruction Revision Rhinoplasty
- Dr. Chayoung Kang
- 2024년 12월 7일
- 5분 분량
This case reviews nasal septum reconstruction revision rhinoplasty in a patient with a history of orthognathic surgery, multiple rhinoplasty procedures, filler injections, alar base reduction, deviated nasal structure, nostril asymmetry, bulbous nasal tip, high nasal starting point related to filler, retracted columella, residual filler, nasal bridge deviation, and functional breathing difficulty. Surgery focused on autologous rib cartilage septal reconstruction, septal extension grafting, filler removal, columella adjustment, tip refinement, nostril symmetry correction, septoplasty, airway support, and closed rhinoplasty structural correction.
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 septum reconstruction revision rhinoplasty in a patient who had undergone orthognathic surgery, multiple rhinoplasty procedures, filler injections, and alar base reduction.
The patient was concerned about nasal asymmetry, deviation, nostril imbalance, a bulbous nasal tip, high nasal starting point caused by filler-related contour changes, retracted columella, and breathing difficulty.
The surgery was performed using a closed rhinoplasty / endonasal approach. The goal was to reconstruct weakened septal support, correct structural imbalance, remove residual filler where identified, improve nostril symmetry, support the nasal tip and columella, and address airway concerns.
Case Background
The patient presented with a complex surgical history involving multiple procedures that had affected both the external nasal shape and internal nasal support.
In revision rhinoplasty cases, the nasal septum may become weakened, deviated, or insufficient because of previous cartilage harvest, surgical manipulation, trauma, or scar tissue.
In this case, simple aesthetic refinement was not enough. The nasal framework needed to be evaluated and reconstructed together with functional airway support.
Key Concerns
The main concerns included:
Deviated nasal structure
Nostril asymmetry
Bulbous nasal tip
High nasal starting point related to filler
Retracted columella
Residual filler causing contour irregularity
Nasal bridge deviation
Functional breathing difficulty
Weakened septal support
These findings suggested that the case required structural reconstruction rather than surface contour correction alone.
Surgical Approach: Septal Reconstruction Through Closed Rhinoplasty
In revision rhinoplasty, the nasal septum is often one of the most important support structures to evaluate.
When the septum is weakened or deviated, the nasal tip, columella, nostrils, bridge alignment, and airway may all be affected.
The approach was selected based on the patient’s anatomy, previous surgical changes, scar tissue, and reconstruction needs.
Structural Problems Identified
Preoperative design consultation photos were reviewed from the frontal, side, oblique, and nostril views. The post-foreign-object-removal appearance was also evaluated.
Main Structural Problems
The main structural problems included:
Septal deviation and structural weakness
Nostril asymmetry
Bulbous nasal tip
Residual filler and irregular contour
Retracted columella
Nasal bridge deviation
Functional airway obstruction
Because these problems involved both the central nasal framework and lower nasal structure, the surgical plan included septal reconstruction, septal extension, filler removal, columella adjustment, and functional correction.
Surgical Plan
1. Autologous Rib Cartilage Septal Reconstruction
Autologous rib cartilage was used to reconstruct the weakened septal support.
This was necessary because the septum plays a central role in supporting the nasal tip, columella, nostril balance, and airway structure.
2. Septal Extension Graft
A septal extension graft was used to support the nasal tip and columella.
This helped improve the relationship between the nasal tip, columella, nostrils, and nasolabial angle.
3. Filler Removal and Contour Correction
Residual filler was removed where it was identified.
The high nasal starting point and irregular contour were corrected within the limits of filler distribution, tissue integration, and scar tissue.
4. Columella Adjustment
The retracted columella was adjusted to improve lower nasal support and side profile balance.
Columella correction was planned together with septal extension because both structures influence tip position and nostril shape.
5. Tip Refinement
The bulbous nasal tip was refined by reshaping and supporting the lower nasal framework.
The goal was to improve tip definition without excessive sharpening or over-projection.
6. Functional Correction
Septoplasty and airway support were included because the patient had functional breathing difficulty.
Functional improvement depends on septal alignment, airway anatomy, mucosal condition, swelling, and healing response.
Surgical Results
Frontal View
From the frontal view, the nasal bridge appeared more aligned after structural correction.
Overall symmetry improved, and the nasal tip appeared more refined after lower nasal framework support.
Lateral View
From the lateral view, the high nasal starting point appeared lowered after filler removal and contour correction.
The nasolabial angle and side profile appeared more balanced after septal extension and columella adjustment.
Oblique View
From the oblique view, the nasal contour appeared smoother, and tip projection appeared more balanced.
Nasal Base View
From the nasal base view, nostril symmetry improved after septal reconstruction, columella adjustment, and lower nasal framework correction.
The columella appeared straighter after structural support and repositioning.
Functional Outcome
Airway support was addressed through septal reconstruction and functional correction.
Because breathing changes depend on internal nasal anatomy, swelling, mucosal condition, previous surgical changes, and healing response, functional improvement should be evaluated over time.
Surgeon’s Commentary
Nasal septum reconstruction is an important part of revision rhinoplasty when the central nasal framework has become weakened or deviated.
Repeated surgeries and filler injections can affect the integrity of the septum, nasal bridge contour, nasal tip support, and airway function.
In this case, autologous rib cartilage was used to rebuild the septal framework. This provided structural support for the nasal tip, columella, nostrils, and airway.
Residual filler was removed where identified, and the nasal contour was adjusted according to the remaining tissue condition.
The retracted columella, bulbous nasal tip, nostril asymmetry, and nasal bridge deviation were corrected together because these findings were connected to the weakened central support structure.
This case shows that nasal septum reconstruction revision rhinoplasty may require combined correction of septal support, filler-related contour changes, nasal tip shape, columella position, nostril symmetry, and airway structure.
FAQ
Why is septal reconstruction necessary in revision rhinoplasty?
Septal reconstruction may be necessary when the original septum is weakened, damaged, deviated, or insufficient after previous surgery, trauma, cartilage harvest, or scar tissue formation.
Why is rib cartilage used for nasal septum reconstruction?
Rib cartilage may be used when stronger or larger cartilage support is needed to rebuild the septum and support the nasal tip, columella, nostrils, and airway.
Can filler be removed during revision rhinoplasty?
Filler may be removed when it is identified during surgery. The extent of removal depends on filler type, location, tissue integration, scar tissue, and surrounding anatomy.
Can breathing improve after septal reconstruction?
Breathing may improve when septal deviation, structural narrowing, or airway support problems are corrected. The degree of improvement depends on airway anatomy, mucosal condition, swelling, and healing.
Is closed rhinoplasty possible for septal reconstruction?
A closed rhinoplasty / endonasal approach may be used in selected revision cases depending on scar tissue, septal condition, structural damage, and reconstruction needs.
International Consultation
For international patients, a photo-based consultation may help clarify whether nasal septum reconstruction revision rhinoplasty, rib cartilage septal reconstruction, septal extension grafting, filler removal, columella adjustment, nostril correction, or functional airway support may be needed.
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