No-Implant Revision Rhinoplasty to Correct an Upturned Nose and Nostril Asymmetry

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13분 전
2분 분량

Surgical Background – No-Implant Revision Rhinoplasty

Preoperative views before no-implant revision rhinoplasty showing frontal and left side profiles — Preoperative design consultation photos: Frontal view, left oblique side view, and left side view.

This case involves a patient who had undergone multiple previous nasal surgeries to correct an upturned nose and nostril asymmetry, yet remained dissatisfied with the results. Her main concerns were excessive nostril show and pinched, uneven nostrils, particularly on one side. Due to repeated procedures and the presence of prior alloplastic materials, a carefully planned no-implant revision rhinoplasty was required to restore both balance and natural appearance.

Surgical history:

12 years ago: Cartilage suturing → resulted in pinching and upturned tip
7–8 years ago: Filler injection at the nasal radix
2 years ago: Ear cartilage graft to the nasal tip
10 months ago: Nostril repositioning using alloplastic dermal graft

Preoperative views before no-implant revision rhinoplasty showing right side and nostril views — Preoperative design consultation photos: Right side view, right oblique side view, and nostril view.

Surgical Plan – Implant-Free Structural Reconstruction

To respect the patient’s preference to avoid synthetic implants, an implant-free surgical plan was developed using donor rib cartilage and the patient’s own septal cartilage.

Key procedures included:

Nasal bridge augmentation using finely carved donor rib cartilage and septal cartilage
Correction of the upturned nasal tip by repositioning it downward
Adjustment of the nasolabial angle to reduce nostril exposure
Right nostril reconstruction using a composite graft (skin + cartilage)
Removal of residual alloplastic materials from previous surgeries

Each step was designed to minimize foreign body risk while restoring natural nasal proportions.

Surgical Results – Natural Balance Without Implants

Postoperative evaluation demonstrated clear improvement in nostril exposure, symmetry, and overall nasal balance.

Frontal view: reduced nostril show and softer, rounder nostril shape
Side profile: corrected over-rotated tip and refined dorsal line without implants
Nostril view: released pinching of the right nostril with improved symmetry

The nose now appears natural and balanced, without reliance on synthetic materials.

Frontal view before and immediately after no-implant revision rhinoplasty — Before Surgery (Left) / Immediately After Surgery (Right)

Before Surgery (Left) / Immediately After Surgery (Right)

Oblique view before and immediately after no-implant revision rhinoplasty — Before Surgery (Left) / Immediately After Surgery (Right)

Nostril view before and immediately after no-implant revision rhinoplasty — Before Surgery (Left) / Immediately After Surgery (Right)

Surgeon’s Commentary – Why a No-Implant Approach Was Essential

This case highlights the importance of an implant-free approach in complex revision rhinoplasty. After multiple prior surgeries, tissue quality can be compromised, and residual foreign materials may interfere with healing and stability.

Using donor rib cartilage and septal cartilage allowed us to reconstruct the nasal framework in a clean, stable environment. The composite graft used for the pinched nostril was particularly important, as cartilage alone cannot adequately restore both volume and skin coverage.

A well-planned no-implant revision rhinoplasty can still achieve natural, balanced results—even in patients with a long history of unsuccessful surgeries.

This surgery was performed by Cha-Young Kang, Chief Director of NoseLab Clinic, using a patient-centered reconstructive approach.