Case at a glance
- Concerns & goals
- Previous treatment
- Surgical plan
- Closed revision rhinoplasty with autologous rib cartilage: The patient's own rib cartilage was harvested to rebuild the nasal framework through an internal approach, without an external nasal incision.
- Autologous dermal grafting: The patient's own dermal tissue was placed beneath skin thinned by repeated operations, reinforcing the soft-tissue coverage and smoothing the nasal contour.
- Nasolabial angle correction: The angle between the nose and upper lip was adjusted to suit the overall facial proportions.
- Graft & material details
- Closed revision rhinoplasty with autologous rib cartilage: The patient's own rib cartilage was harvested to rebuild the nasal framework through an internal approach, without an external nasal incision.
- Autologous dermal grafting: The patient's own dermal tissue was placed beneath skin thinned by repeated operations, reinforcing the soft-tissue coverage and smoothing the nasal contour.
- Photo timing
These details are excerpts from the original article and captions. Follow a detail to read it in context.
Hello, I am Dr. Peter C. Kang, Medical Director of NOSELAB Clinic. Today, I would like to introduce a revision rhinoplasty case involving nostril asymmetry, nasal deviation, and a septal perforation after multiple operations over many years.
Surgical History
The patient's surgical history spanned approximately 27 years, beginning with rhinoplasty using ear cartilage and a silicone implant. Further operations followed because of continued dissatisfaction with the nasal shape. Osteotomies and septal correction had also been attempted without resolving the underlying concerns.
The most recent rhinoplasty used a silicone implant and the patient's own rib cartilage. Six months later, another revision was performed for asymmetry. By the time of the consultation at NOSELAB, repeated operations had left complex changes in the internal nasal tissues.
The Patient's Goals
Improve the difference between the two nostrils.
Correct the deviation so that the nose appeared centered from the front.
Create a more refined nasal contour.
Repair the septal perforation identified during the preoperative assessment.
Surgical Plan and Procedure
After reviewing the surgical history and the condition of the nasal tissues, we performed the following procedures:
Closed revision rhinoplasty with autologous rib cartilage: The patient's own rib cartilage was harvested to rebuild the nasal framework through an internal approach, without an external nasal incision.
Autologous dermal grafting: The patient's own dermal tissue was placed beneath skin thinned by repeated operations, reinforcing the soft-tissue coverage and smoothing the nasal contour.
Nasolabial angle correction: The angle between the nose and upper lip was adjusted to suit the overall facial proportions.
Septoplasty and turbinate surgery: The deviated septum and enlarged turbinate tissue were addressed to improve functional problems such as nasal obstruction.
Septal perforation repair: Skin and perichondrial grafts were used to repair the perforation.
Septal reconstruction: The damaged septum was rebuilt with autologous rib cartilage to provide firm support.
Septal extension grafting: The reconstructed septum supported correction of the tip's projection and direction.
Surgical Results
Frontal view
Nostril asymmetry improved.
The overall nasal contour became more refined.
The corrected nose appeared more centered from the front.
Profile view
A more natural nasolabial angle improved the balance of the facial profile.
Stable repositioning of the tip created a natural side contour.
Nostrils and internal structure
Repair of the septal perforation restored the integrity of the internal nasal structure.
The shape and size of the nostrils became more balanced.
Surgeon's Perspective
When a septal perforation develops after repeated nasal surgery, treatment may require reconstruction of the internal framework as well as cosmetic correction. In a patient with such an extensive surgical history, the tissues can be substantially altered.
In this case, rib cartilage provided the main structural support, while autologous dermis, skin grafts, and perichondrial grafts addressed the different tissue deficiencies. Combining perforation repair with functional nasal surgery allowed us to pursue improvements in both appearance and breathing.
Thank you for reading. I am Dr. Peter C. Kang, Medical Director of NOSELAB Clinic.
Information About These Photographs and Surgical Risks
These before-and-after photographs show an individual patient's results. Discuss your expected outcome with your doctor.
All surgery carries a risk of complications, including the following:
Infection: Disinfection and injectable or oral antibiotics are used to help prevent infection. In rare cases (less than 0.5%), another operation may be required.
Bleeding: Nasal packing is used for one to two days to help minimize bleeding. Bleeding may occasionally occur after surgery for nasal inflammation or obstruction.
Allergic reactions.
Residual asymmetry: Facial asymmetry and the condition of the nose may prevent complete correction, as explained during consultation.
Insufficient cosmetic or functional improvement.
Other complications, including excessive scar formation and skin necrosis.
Read the author’s background and the original case context. About these articles
