Nasal Bone Fracture Reconstruction Rhinoplasty with Staged Dorsal Refinement

Dr. Chayoung Kang
2025년 5월 2일
5분 분량

This case reviews nasal bone fracture reconstruction rhinoplasty in a patient with recent nasal trauma, nasal bone deviation, previous filler treatment, prior silicone and rib cartilage rhinoplasty, an overly elevated nasal dorsum, drooping nasal tip, retracted columella, and nostril asymmetry. Surgery was planned as a staged closed rhinoplasty approach, beginning with fracture reduction and nasal tip reconstruction, followed by planned dorsal refinement after bone healing.

Author: Dr. Cha-Young Kang
Clinic: NoseLab Clinic
Published: 2025
Last Updated: 2026

Introduction

Hello, this is Dr. Cha-Young Kang of NoseLab Clinic.

This case involves nasal bone fracture reconstruction rhinoplasty in a patient who had recent nasal trauma resulting in a nasal bone fracture. The patient also had a previous rhinoplasty history and an excessively elevated nasal dorsum.

Because the case involved both trauma and previous nasal surgery, the operation was planned as a two-stage closed rhinoplasty / endonasal approach. The first stage focused on fracture reduction and nasal tip support. Dorsal refinement was planned for a second stage after bone healing.

Patient History and Nasal Trauma

The patient had a history of previous nasal procedures before the recent nasal trauma.

Previous History

The patient history included:

6 years ago: Nasal filler, later dissolved
4 years ago: Silicone and rib cartilage rhinoplasty
1 week before surgery: Nasal trauma resulting in nasal bone fracture

Because the patient already had a history of filler treatment and implant-based rhinoplasty, the fracture reconstruction had to consider not only the fractured nasal bone but also the previous implant, cartilage support, tissue condition, and dorsal height.

Preoperative design consultation photos of a male patient – frontal, left side, and oblique side views for closed rhinoplasty planning — Preoperative design consultation: frontal, left side, and left oblique views

Initial Analysis – Fracture and Structural Deformities

Preoperative design consultation photos were reviewed from the frontal, side, oblique, and nostril views.

Frontal View

The frontal view showed that the nasal bone was severely deviated to the right after trauma. The nasal tip was also shifted, and the overall nasal shape appeared broad and unbalanced.

Side View

The side view showed an overly elevated nasal dorsum, drooping nasal tip, and retracted columella. These findings suggested that dorsal height and tip position would need to be addressed separately.

Nostril View

The nostril view showed nostril asymmetry and columella deviation toward the right side.

These findings confirmed that this was not a simple nasal fracture reduction case. The surgical plan needed to address traumatic deviation, nasal tip support, columella position, and staged dorsal refinement.

eoperative design consultation images of a male patient – right side view, oblique side view, and nostril base view taken for closed rhinoplasty planning. — Preoperative design consultation: right side, right oblique, and nostril views

Patient’s Concerns and Goals

The patient’s main concerns included the fractured nasal bone, excessive dorsal height, and overall nasal imbalance after trauma.

Main Goals

The main goals included:

Repositioning of the fractured nasal bone
Correction of traumatic nasal deviation
Improvement of nasal tip position
Correction of columella deviation
Improvement of nostril asymmetry
Planning for dorsal height reduction or refinement
Maintaining structural support during healing

Because the nasal bone fracture was recent, the priority was to restore alignment and stabilize the nasal tip first. Dorsal refinement was planned as a second-stage procedure after the fractured bone had healed.

Can Nasal Bone Fracture Reconstruction and Aesthetic Rhinoplasty Be Performed Together?

Whether nasal bone fracture reconstruction and aesthetic rhinoplasty can be performed together depends on the fracture type, nasal bone stability, swelling, soft tissue condition, and previous surgical history.

In the referenced classification of nasal bone fracture, milder fracture types may allow simultaneous cosmetic correction, while more complex fracture patterns require case-by-case judgment. In more severe cases, initial cosmetic surgery may not be recommended.

This case was classified as Type IIIo, so a staged approach was selected.

CT scan classification of nasal bone fractures by type – Type I, IIo, IIs, IIIo, IIIs, and IV – showing anatomical diagrams and corresponding coronal and axial CT images. — Classification of nasal bone fracture

Why a Staged Approach Was Selected

The patient had both recent fracture and previous rhinoplasty changes. CT imaging also showed remnants of previous osteotomy. These factors made immediate full dorsal refinement less predictable.

For that reason, the first stage focused on closed nasal fracture reduction and nasal tip reconstruction. Dorsal augmentation or refinement was deferred until after bone healing.

Surgical Strategy – Two-Stage Closed Rhinoplasty

The surgical plan was divided into two stages to separate fracture stabilization from final dorsal refinement.

First Stage

The first-stage surgery included:

Closed nasal fracture reduction
Correction of traumatic nasal bone deviation
Nasal tip reconstruction using autologous rib cartilage
Columella repositioning
Nostril balance correction
No new dorsal implant placement during the first stage

The purpose of the first stage was to restore the fractured nasal bone alignment and stabilize the nasal tip while avoiding excessive manipulation of the healing nasal bone.

Second Stage

The second stage was planned after bone healing.

The planned second-stage goals included:

Dorsal refinement
Adjustment of excessive dorsal height
Possible rib cartilage dorsal augmentation or contour correction
Final aesthetic refinement after the fracture site stabilized

This staged plan allowed the initial trauma correction and later dorsal refinement to be managed separately.

Postoperative Results After the First Stage

rontal view comparison before (left) and immediately after (right) nasal fracture reconstruction and high dorsum correction surgery. — Frontal view before surgery (left) and immediately after first-stage surgery (right)

Frontal View

From the frontal view, the fractured nasal bone was realigned, and the nasal tip appeared more centralized. The nasal axis improved after closed fracture reduction and tip reconstruction.

Side View

From the side view, nasal tip projection improved after rib cartilage support. The columella position was also adjusted. The elevated dorsal height was intentionally left for later refinement in the second stage.

Structural Outcome

The first-stage procedure improved traumatic deviation and nasal tip alignment while preserving the option for later dorsal refinement.

Because this was a trauma case with previous rhinoplasty history, the outcome was planned within the limits of swelling, fracture healing, previous osteotomy changes, and existing tissue condition.

Surgeon’s Commentary

코뼈 재건 직후 촬영된 정면, 측면, 비스듬한 측면 사진으로 수술 직후 부기와 정렬 상태를 보여줌 — Immediately after first-stage surgery: frontal, side, and oblique views

This case involved both nasal trauma and previous rhinoplasty-related complexity. The patient had a recent nasal bone fracture, previous filler treatment, previous silicone and rib cartilage rhinoplasty, and CT findings suggesting previous osteotomy remnants.

In this situation, performing every correction at once could increase surgical unpredictability. A staged plan allowed the fractured bone to be corrected first while preserving a safer surgical environment for later dorsal refinement.

The first-stage surgery was performed using a closed rhinoplasty / endonasal approach. This allowed fracture reduction and internal nasal tip reconstruction without an external columellar incision.

Autologous rib cartilage was used to reinforce nasal tip support. The dorsal height was not fully refined during the first stage because the fractured bone needed time to heal.

This case shows that nasal bone fracture reconstruction rhinoplasty after previous nasal surgery should be planned carefully. Trauma correction, previous surgical changes, bone healing, nasal tip support, and dorsal contour all need to be evaluated together.

FAQ

Can nasal fracture repair and rhinoplasty be done together?

They can sometimes be performed together, but the decision depends on fracture type, swelling, bone stability, soft tissue condition, and previous surgical history. Complex fractures may require a staged plan.

Why was this case treated in two stages?

This case involved a recent nasal bone fracture, previous rhinoplasty, and CT findings related to prior osteotomy. The first stage focused on fracture reduction and nasal tip support, while dorsal refinement was planned after bone healing.

Why was no implant used during the first stage?

No new dorsal implant was used during the first stage because the fractured bone needed to heal first. Dorsal contour correction was deferred to reduce excessive manipulation of the healing nasal bone.

Why is rib cartilage used in nasal fracture reconstruction?

Rib cartilage may be used when stronger nasal tip support is needed, especially in patients with previous rhinoplasty history or weakened internal support.

When can second-stage dorsal refinement be considered?

Second-stage dorsal refinement can be considered after fracture healing and soft tissue stabilization. The timing depends on bone stability, swelling, tissue condition, and surgical assessment.

International Consultation

For international patients, a photo-based consultation may help clarify whether nasal bone fracture reconstruction rhinoplasty, staged closed rhinoplasty, rib cartilage nasal tip reconstruction, or dorsal refinement may be needed.

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