Septal Cartilage Overharvest Correction with Rib Cartilage Reconstruction
- Dr. Chayoung Kang
- 2025년 6월 5일
- 6분 분량
This case reviews septal cartilage overharvest correction in a patient who developed nasal instability, shortened nasal tip, nostril asymmetry, deviated nasal bridge, drooping columella, unfavorable nasolabial angle, and chronic rhinitis symptoms after multiple previous rhinoplasty procedures. Surgery focused on rib cartilage septal reconstruction, septal extension, nasal tip lengthening, lateral osteotomy, nostril symmetry correction, columella repositioning, septoplasty, and inferior turbinate reduction.
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 septal cartilage overharvest correction in a patient who had undergone multiple rhinoplasty procedures over an 18-year period. The patient developed nasal instability, nasal deviation, shortened nasal tip, nostril asymmetry, and chronic rhinitis symptoms.
During surgery, severe septal support deficiency was identified. The previous septal cartilage harvesting had extended into important supporting structures, leaving the septum structurally compromised.
The surgery was performed using a closed rhinoplasty / endonasal approach. The goal was to reconstruct the weakened septal framework with autologous rib cartilage, improve nasal tip support, correct deviation, and address functional nasal obstruction.
Patient Background and Surgical History
The patient had a complex history of facial trauma surgery and multiple previous rhinoplasty procedures.
Previous Surgical History
The surgical history included:
2012: Right zygomatic fracture surgery
18 years ago: First rhinoplasty with ear cartilage and silicone implant, followed by deviation to one side
10 years ago: Revision using ear cartilage, silicone implant, and septal cartilage, followed by opposite deviation and cartilage show-through
2 years ago: Revision rhinoplasty using rib cartilage, silicone implant, and ear cartilage
After these surgeries, the nasal structure became unstable. The patient developed a shortened nasal tip, nostril asymmetry, deviated nasal bridge, drooping columella, and chronic rhinitis symptoms.
Because the patient had undergone multiple previous procedures, the revision plan required careful evaluation of scar tissue, remaining septal support, previous graft materials, and airway function.
Initial Assessment
Preoperative design consultation photos were reviewed from the frontal, side, oblique, and nostril views. Functional symptoms were also evaluated.
Functional Concerns
The patient had chronic rhinitis symptoms and nasal breathing discomfort. Functional correction needed to be included in the surgical plan.
Aesthetic and Structural Concerns
The main structural and aesthetic concerns included:
Shortened nasal tip
Nostril asymmetry
Deviated nasal bridge
Drooping columella
Unfavorable nasolabial angle
Cartilage show-through from previous surgery
Weak internal nasal support
Chronic rhinitis symptoms
These findings suggested that the problem was not limited to the outer nasal shape. The internal septal support structure also needed reconstruction.
Intraoperative Findings
During surgery, excessive previous harvesting of septal cartilage was identified.
Septal Cartilage Deficiency
The septal cartilage had been overharvested, including areas important for structural support. This caused severe compromise of septal stability.
The septum functions as a central support structure for the nose. When too much cartilage is removed, especially from key supporting areas, the nose may lose internal stability over time.
Secondary Structural Problems
The septal support deficiency contributed to secondary problems, including nasal tip shortening, nostril asymmetry, columella imbalance, and nasal deviation.
Because the remaining septal structure was weak, simple tip reshaping would not have been enough. Structural reconstruction was required.
Patient Goals
The patient wanted improvement in both nasal function and shape.
Main Goals
The main goals included:
Correct the shortened nasal tip
Improve chronic rhinitis-related symptoms
Improve nostril asymmetry
Correct nasal bridge deviation
Refine columella position
Improve nasolabial angle balance
Reconstruct weakened septal support
Improve nasal airflow support
The surgical plan was designed to rebuild the internal support first, then adjust the external nasal shape based on the reconstructed framework.
Surgical Approach for Septal Cartilage Overharvest Correction
The surgical approach combined septal reconstruction, structural restoration, nasal bone correction, nostril correction, and functional airway surgery.
Rib Cartilage Septal Reconstruction
Autologous rib cartilage was used to reconstruct the deficient septal framework.
This step was necessary because the existing septal cartilage was not sufficient to provide stable support. Rib cartilage was selected because stronger structural material was needed for reconstruction after overharvest.
Septal Extension with Rib Cartilage
Septal extension was performed using rib cartilage to lengthen and support the shortened nasal tip.
This helped improve the tip position and provided a more stable base for nasal tip correction.
Correction of Nasal Deviation with Lateral Osteotomy
Lateral osteotomy was performed to correct nasal bone deviation and improve the nasal axis.
Because the nasal bridge was deviated, bone-level correction was needed along with septal reconstruction.
Nostril Symmetry Correction
Nostril asymmetry was improved by correcting tip support, septal alignment, and lower nasal balance together.
In cases of septal support deficiency, nostril asymmetry can be related to both internal framework weakness and external cartilage imbalance.
Columella Repositioning
The drooping columella was repositioned and aligned to improve the nasolabial angle and side profile balance.
This step helped improve the relationship between the nasal tip, columella, and upper lip.
Septoplasty and Inferior Turbinate Reduction
Septoplasty was performed together with submucosal reduction of the inferior turbinates using radiofrequency.
These functional procedures were included to improve nasal airflow and reduce obstruction related to septal deviation and turbinate hypertrophy.
Surgical Outcomes
Functional Outcome
Nasal congestion improved after septoplasty, inferior turbinate reduction, and structural airway support.
The surgical plan addressed both the internal airway and the weakened nasal framework.
Frontal View
From the frontal view, the nasal bridge appeared more aligned after correction, and nostril asymmetry improved. The nasal structure appeared better supported after septal reconstruction.
Profile View
From the profile view, nasal tip projection and length improved after rib cartilage support. The columella position was adjusted, and the nasolabial angle appeared more balanced.
Structural Stability
The septal framework was reconstructed with autologous rib cartilage. This provided stronger support for the nasal tip and helped improve the overall nasal framework.
Because this was a multiple revision case, the outcome was planned within the limits of scar tissue, previous grafting, cartilage deficiency, and tissue condition.
Surgeon’s Commentary
This case shows how aggressive septal cartilage harvesting can affect long-term nasal support. The septum is one of the central support structures of the nose, and excessive removal can lead to instability, deviation, tip shortening, and nostril asymmetry.
In this patient’s case, previous septal cartilage harvesting had compromised the internal support structure. As a result, the nasal tip became shortened, nostril asymmetry worsened, and the nasal bridge remained deviated.
Autologous rib cartilage was used to reconstruct the septal framework because the remaining septal cartilage was insufficient. Rib cartilage provided the structural support needed for septal reconstruction and tip lengthening.
Lateral osteotomy was performed to correct the deviated nasal bones. Septoplasty and inferior turbinate reduction were also included to address functional airway symptoms.
The goal of this surgery was to rebuild support first. In complex revision rhinoplasty, external shape correction depends on the stability of the internal framework.
This case highlights the importance of preserving key nasal support structures during previous surgery and planning reconstruction carefully when septal cartilage has been overharvested.
FAQ
What is septal cartilage overharvest?
Septal cartilage overharvest means that too much cartilage has been removed from the septum during a previous surgery. If key support areas are removed, the nose may lose internal structural stability.
What problems can occur after septal cartilage overharvest?
Possible problems include nasal instability, shortened nasal tip, nostril asymmetry, columella changes, nasal deviation, cartilage show-through, and breathing discomfort. The exact symptoms depend on how much support remains.
Why is rib cartilage used for septal reconstruction?
Rib cartilage may be used when the remaining septal cartilage is insufficient for reconstruction. It can provide stronger support for rebuilding the septal framework and stabilizing the nasal tip.
Can breathing problems improve after septal reconstruction?
Breathing may improve when septal deviation, turbinate hypertrophy, or structural airway narrowing is corrected. The degree of improvement depends on the patient’s internal nasal condition and healing process.
Can nostril asymmetry improve after septal cartilage overharvest correction?
Nostril asymmetry can improve when septal support, nasal tip position, columella alignment, and lower nasal balance are corrected together. The degree of improvement depends on scar tissue and previous surgical changes.
International Consultation
For international patients, a photo-based consultation may help clarify whether septal cartilage overharvest correction, rib cartilage septal reconstruction, nasal tip lengthening, nostril asymmetry correction, or functional airway surgery may be needed.
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