Reconstructive Rhinoplasty Following Absorbed Alloplastic Graft and Severe Septal Damage – A Complex Revision Case

Hello, this is Dr. Cha-Young Kang, Director of Nose Lab Clinic.

Today, I’d like to present a complex revision rhinoplasty case involving a patient who had undergone six prior surgeries over 14 years, including episodes of inflammation, alloplastic material absorption, and severe septal cartilage damage.

Design Consultation: Frontal View, Left Side View, and Oblique Side View Photos

Design Consultation: Right Oblique Side View, Side View, and Nostril View Photos

📍 Surgical History

• 14 years ago: Silicone implant with auricular cartilage graft – tip extrusion and dorsal deviation

• 12 years ago: Repeat silicone and cartilage surgery – dissatisfied with contour

• 10 years ago: Silicone + donor rib cartilage + ear cartilage – dissatisfied with sharp tip

• 9 years ago: Silicone + donor rib cartilage + gluteal dermis – satisfactory shape, but developed inflammation

• 9 years ago (2 weeks later): Full implant removal due to infection

• 3 years ago: Donor dermis (dorsum) + autologous rib cartilage graft

🔎 Initial Concerns

Functional

• Difficulty breathing when lying on the right side

Aesthetic

• Dorsum irregularity from partially absorbed alloplastic dermal graft

• Unnaturally high radix with sharp profile

• Rightward deviation from the front

• Overprojected, pointed tip

• Severely damaged septal cartilage

• Deviated columella and nostril asymmetry

Special Considerations

• Severely thinned dorsal skin due to repeated surgery

• Tissue damage from past infection

✨ Patient Goals

• Create a soft, rounded nasal tip

• Lower the radix to soften facial expression

• Slightly shorten perceived nasal length while avoiding upturned appearance

• Achieve a natural, balanced result

• Realign the columella

• Improve the protrusive lip appearance

💉 Surgical Plan

Tissue & Skin Management

• Removed partially absorbed alloplastic dermis from the dorsum

• Reinforced thin nasal skin using postauricular dermal grafts

• Performed three sessions of stem cell therapy to enhance tissue healing

Structural Reconstruction

• Rebuilt the severely damaged septal cartilage using autologous rib cartilage

• Corrected dorsal deviation and columellar asymmetry

• Softened the pointed tip

• Realigned columella and improved nostril symmetry

• Lowered radix height for a softer profile

• Refined columella-labial angle

Functional Improvement

• Septoplasty and inferior turbinate reduction (for rhinitis and nasal obstruction)

✅ Surgical Outcomes

Function

• Resolved positional breathing discomfort

• Significantly improved nasal airflow

Before (Left) / Immediately After (Right)

Frontal View

• Natural dorsal height restored

• Midline alignment corrected

• Soft, voluminous nasal tip achieved

• Corrected columella and nostril symmetry

Before (Left) / Immediately After (Right)

Profile View

• Lowered radix created a softer transition

• Restored ideal nasal length

• Tip projection refined

• Improved columella-labial angle reduced lip protrusion

Before (Left) / Immediately After (Right)

Base View

• Corrected columella deviation

• Improved nostril symmetry and natural shape

Before (Left) / Immediately After (Right)

👨‍⚕️ Surgeon’s Commentary

Immediately After Surgery: Frontal, Side, and Oblique Side View Photos

Immediately After Surgery: Nostril View Photo

This case involved one of the most challenging forms of revision rhinoplasty, where multiple previous surgeries had resulted in severe tissue damage, cartilage loss, and inflammation. The patient presented with a visibly sharp, deviated, and disproportionate nose, along with compromised breathing..

A key concern was the partial absorption of an alloplastic dermal graft, which led to dorsal irregularities and a harsh profile. Additionally, the over-projected and pointed nasal tip created an unnatural appearance, especially when paired with a high radix.

We approached this with a meticulous reconstruction using the patient’s own rib cartilage. The septal framework was completely rebuilt to provide both support and symmetry. To correct the thin, damaged skin, we reinforced the dorsum with autologous dermis and applied stem cell therapy to encourage recovery.

By addressing both the structural and surface-level concerns, we achieved a stable, natural nasal shape. The result was a balanced and aesthetically pleasing nose that better suited the patient’s facial features—without compromising function.

This case demonstrates the power of comprehensive reconstructive strategies, even in the most complex post-inflammatory revision scenarios.

Thank you,

Dr. Cha-Young Kang

Nose Lab Clinic

https://blog.naver.com/cykang/223871783598