Reconstruction of Structural Instability Due to Overharvested Septal Cartilage โ A Long-Term Revision Case
- noselab
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Hello, this is Dr. Cha-Young Kang, Medical Director at Nose Lab Clinic.
Today, Iโm sharing a case involving the structural reconstruction of a nose with severe instability caused by overharvesting of the septal cartilage. This patient underwent three previous rhinoplasty procedures over an 18-year span, ultimately leading to nasal collapse and aesthetic asymmetry.
Design Consultation: Frontal View, Left Side View, and Oblique Side View Photos
๐ Surgical History
2012: Right zygomatic fracture surgery
18 years ago: First rhinoplasty with ear cartilage + silicone โ resulted in deviation to one side
10 years ago: Ear cartilage + silicone + septal cartilage โ opposite deviation and cartilage show-through
2 years ago: Rib cartilage + silicone + ear cartilage revision
Design Consultation: Right Oblique Side View, Side View, and Nostril View Photos
๐ Initial Assessment
Functional Concerns
Chronic rhinitis symptoms
Aesthetic and Structural Issues
Shortened nasal tip
Nostril asymmetry
Deviated nasal bridge
Drooping columella and unfavorable nasolabial angle
Intraoperative Findings
Excessive harvesting of septal cartilage, including bony support
Resulting severe structural compromise of septal stability
Tip shortening and nostril asymmetry as secondary complications
โจ Patient Goals
Correct shortened nasal tip
Treat rhinitis symptoms
Improve nostril asymmetry
Refine columella and nasolabial angle
๐ Surgical Approach
Septal Reconstruction
Addressed severe septal cartilage deficit using autologous rib cartilage
Rebuilt a strong, stable septal support structure
Structural Restoration
Performed septal extension with rib cartilage
Lengthened shortened nasal tip
Corrected nasal deviation using lateral osteotomies
Improved nostril symmetry
Aesthetic Refinement
Lowered and aligned the columella
Refined the nasolabial angle for a more elegant profile
Functional Enhancement
Septoplasty combined with submucosal resection of inferior turbinates using radiofrequency
Improved nasal airflow and reduced rhinitis symptoms
โ Surgical Outcomes
Functional
Marked relief of nasal congestion
Improved overall breathing
Before (Left) / Immediately After (Right)
Frontal View
Realigned nasal bridge
Corrected nostril asymmetry
Stabilized nasal structure
Before (Left) / Immediately After (Right)
Profile View
Recovered nasal tip projection and length
Naturally lowered columella
Refined nasolabial angle
Harmonized side profile
Before (Left) / Immediately After (Right)
Structural Stability
Secure reconstruction of the septum
Improved long-term integrity and aesthetics of nasal framework
Before (Left) / Immediately After (Right)
๐จโโ๏ธ Specialist Commentary
Immediately After Surgery: Frontal, Side, and Oblique Side View Photos
Immediately After Surgery: Nostril View Photo
This case exemplifies the risks of aggressive septal cartilage harvesting. The septum is the central pillar supporting the nasal structure; when overharvested, especially into the bony septum, long-term collapse and deformity can occur. In this patientโs case, excessive removal led to compromised support, tip retraction, and worsening asymmetry.
By reinforcing the nasal septum using robust autologous rib cartilage, we were able to restore both support and alignment. The nasal tip was lengthened and stabilized, the nostrils were rebalanced, and the columella was elegantly reshaped to enhance the nasolabial transition.
Additionally, lateral osteotomies corrected the deviated nasal bones, and functional breathing issues were addressed via septoplasty and turbinate reduction. The comprehensive approach not only restored a more refined nasal form but also delivered sustainable functional improvements.
This case highlights the importance of preserving critical nasal support structures during surgery, and how thoughtful reconstruction using autologous grafts can yield stable, long-lasting, and aesthetically satisfying resultsโeven after multiple prior surgeries.
Thank you,
Dr. Cha-Young Kang
Director, Nose Lab Clinic
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