Septal Perforation Rhinoplasty with Rib Cartilage Nose Reconstruction
- Dr. Chayoung Kang
- 2025년 6월 18일
- 6분 분량
최종 수정일: 5월 7일
This case reviews septal perforation rhinoplasty in a patient with a complex 14-year surgical history, repeated inflammation, damaged septal cartilage, and nasal tip skin thinning. Reconstruction was performed using autologous rib cartilage to restore septal support, close the perforation, rebuild the nasal framework, and improve breathing function.
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 perforation rhinoplasty in a patient who had undergone multiple nasal surgeries over 14 years. The patient presented with a 7x9mm septal perforation, severely damaged septal cartilage, chronic rhinitis, impaired breathing, and visible cartilage beneath thin nasal tip skin.
The surgery was performed using a closed rhinoplasty / endonasal approach with autologous rib cartilage reconstruction. The goal was to repair the internal septal structure, improve nasal breathing, and rebuild the nasal tip and framework with long-term structural stability in mind.
Patient Background and Surgical History
The patient had a long and complex surgical history involving several implant materials, cartilage grafts, filler treatment, and repeated revision procedures.
Previous Nasal Procedures
The surgical history included:
14 years ago: Gore-Tex implant and ear cartilage graft
13 years ago: Silicone implant, alar base reduction, and osteotomy
12 years ago: Implant removal from the glabella area due to inflammation
10 years ago: Filler injection along the nasal dorsum and tip after implant removal
9 years ago: Filler removal, silicone implant, ear cartilage graft, and repeated alar base reduction
Most recently: Silicone implant, ear cartilage graft, and nasal tip augmentation using gluteal dermis
After repeated operations and long-term inflammation, the nasal structure became weakened. The septal cartilage was severely compromised, and the nasal tip skin became thin enough for underlying cartilage irregularities to become visible.
Initial Evaluation
Preoperative evaluation included design consultation photos, nasal endoscopy, and structural assessment of the nasal framework.
Functional Problems
The main functional problems included:
7x9mm septal perforation
Severely damaged septal cartilage
Chronic rhinitis
Impaired nasal breathing
The septal perforation was clinically important because it affected the internal nasal support and contributed to breathing symptoms. The damaged septum also limited the available internal support for revision reconstruction.
Aesthetic and Structural Concerns
The external nasal concerns included:
Visible cartilage through thin nasal tip skin
Irregular nasal tip contour
Protrusive mouth profile
Asymmetrical nostrils
Limited correction range due to previous alar base reduction
In this type of case, the visible shape problem is only one part of the diagnosis. The deeper issue is the loss of structural support, tissue thinning, and the presence of septal damage after repeated procedures.
Patient Goals
The patient wanted to improve both nasal function and overall facial balance.
The main goals were:
Improve breathing function
Repair the septal perforation
Create a more stable nasal framework
Reduce visible cartilage irregularity at the nasal tip
Improve the nose–upper lip transition
Soften the protrusive appearance of the mouth area
Improve nostril asymmetry within realistic surgical limits
Because the patient had already undergone repeated alar base reduction, complete correction of nostril asymmetry was limited. This limitation was reviewed during surgical planning.
Surgical Plan
The surgical plan focused on internal reconstruction first. In a complex revision case with septal perforation, the priority is not simply changing the nasal profile. The damaged septum, weakened nasal tip skin, and unstable framework must be addressed together.
Septal Perforation Repair
The 7x9mm septal perforation was repaired through full septal reconstruction using autologous rib cartilage. The purpose was to restore internal support and reduce the functional problems associated with the perforation.
Septal Reconstruction with Rib Cartilage
Autologous rib cartilage was used to reconstruct the severely damaged septal support structure. This provided a more stable central framework for the nose, especially in a case where the native septal cartilage had been significantly weakened.
Removal of Malformed Cartilage and Damaged Tissue
Previously grafted cartilage had become fused and irregular beneath the thin nasal tip skin. Malformed cartilage and compromised tissue were carefully removed to create a cleaner foundation for reconstruction.
Nasal Tip Skin Reinforcement with Dermal Grafting
Because the nasal tip skin was severely thinned, dermal grafting was used to reinforce the compromised soft tissue layer. This helped reduce the visibility of underlying cartilage and provided additional soft tissue coverage.
Nasal Framework Reconstruction
The nasal framework was rebuilt using rib cartilage to improve structural stability. The reconstruction focused on septal support, nasal tip definition, columellar support, and the overall nasal contour.
Functional Airway Correction
Functional correction included septoplasty and turbinate reduction to improve nasal airflow and reduce chronic rhinitis-related symptoms.
Nasolabial Angle and Profile Refinement
The nasolabial angle was refined to create a smoother transition between the columella and upper lip. This helped soften the protrusive appearance of the mouth area while maintaining a natural side profile.
Surgical Results
Functional Recovery
The septal perforation was closed in this case, and nasal breathing improved after structural reconstruction. Rhinitis-related symptoms were also reduced after functional airway correction.
Frontal View
From the frontal view, the nasal contour appeared more balanced. The nasal tip and central nasal framework showed improved stability after reconstruction.
Side View
From the side view, the nasolabial angle appeared smoother, and the transition between the nose and upper lip became more balanced. The side profile showed improved structural support without excessive projection.
Oblique View
The oblique view showed improved nasal tip contour and a smoother line from the nasal bridge to the tip. The previous irregularities related to thin skin and visible cartilage were reduced.
Nostril View
The nostril view showed visible improvement within the limits created by previous alar base reduction. Complete symmetry was not the goal; the focus was to improve support, balance, and stability within a realistic surgical range.
Nasal Tip
The visible cartilage problem at the nasal tip was improved by removing irregular grafted cartilage, rebuilding the framework, and reinforcing the thin soft tissue with dermal grafting.
Surgeon’s Commentary
This was a highly complex revision rhinoplasty case involving seven nasal surgeries over 14 years, repeated inflammation, septal cartilage damage, a 7x9mm septal perforation, and severe thinning of the nasal tip skin.
The most important part of this surgery was the septal perforation repair. When the septum is damaged and perforated, nasal support and breathing function can both be affected. For that reason, the surgery required full septal reconstruction rather than a simple cosmetic revision.
Autologous rib cartilage was used because the existing septal cartilage was severely compromised. In complex revision cases, rib cartilage can provide the structural strength needed to rebuild the septum, support the nasal tip, and stabilize the nasal framework.
The nasal tip also required careful management. Previous cartilage grafts had become irregular and visible beneath thinned skin. Removing the malformed cartilage, reinforcing the soft tissue, and rebuilding the tip structure were necessary to reduce future tissue stress.
Nostril asymmetry was approached conservatively because the patient had already undergone alar base reduction in previous surgeries. In these cases, attempting excessive correction may create additional tension or distortion. The goal was to achieve meaningful improvement within safe anatomical limits.
This case shows that septal perforation rhinoplasty should be planned as structural and functional reconstruction, especially when multiple previous surgeries, tissue thinning, and airway symptoms are present.
FAQ
Why is septal perforation rhinoplasty more complex than standard revision rhinoplasty?
Septal perforation rhinoplasty is more complex because the internal septal support is damaged. The surgery must address both the perforation and the structural framework needed for nasal stability and breathing function.
Can rib cartilage be used to repair a septal perforation?
Yes, autologous rib cartilage may be used when the septal cartilage is severely damaged or insufficient. It can provide strong structural support for septal reconstruction and complex revision rhinoplasty.
How does thin nasal tip skin affect revision rhinoplasty?
Thin nasal tip skin can make underlying cartilage irregularities more visible and can increase the risk of contour problems. In these cases, soft tissue reinforcement such as dermal grafting may be needed.
International Consultation
For international patients, a photo-based consultation may help clarify whether septal reconstruction, rib cartilage nose reconstruction, or functional correction may be needed.
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