Hello! I am Dr. Chayoung Kang, Director of Noselab Clinic.
Today we will talk about a case of nasal contracture. This patient had officially undergone 27 rhinoplasty surgeries, including one nasal fat transplant, which led to contracture progressing rapidly within the last year.
Surgical plan
This patient wanted a high and refined nose but, the current state of her nose expected to be poor, so I explained to her that I would shape the nose in consideration to its current condition, and went into the surgery. In particular, since there was a possibility of acute inflammation, we also carefully discussed the possibility of needing a second operation. The CT scan taken before the surgery, we could observe the shape of the foreign body at the tip of the nose, which was possibly causing damage to the septal cartilage.
Surgical findings
The foreign substance observed in the CT scan was a piece of silicone, and it is thought that the previous surgeon had filled the area where the septal cartilage at the nose tip had disappeared by using a silicone prosthesis. The prosthesis was pushed to the tip of the nose, and the skin at the top was open about 0.5 mm. Acute inflammation spread between the prosthesis and the fat cells transplanted into the nose, and the granulation tissue filled the surrounding area of the prosthesis. When the granulation tissue was completely removed, and the inside of the nose was checked, 80% of the septal cartilage had disapperared, and only traces of the upper and lower septal cartilage remained. The fat cells transplanted into the nose bridge were also sufficiently removed because they were also causing a state of deformity caused by scar and fibrous tissue due to the chronic inflammation.
Before and After Surgery Photos
Now we will take a look at the side-by-side comparison before and after the surgery.
Before the surgery, the nose tip looked excessively lifted, the part where the columella was lifted was considerably improved and the nasolabial angle was made to look more natural. Also, the nasal bridge starting point was lowered to a more natural-looking line.
The lowered nasal bridge is the most noticeable improvement.
The nostrils that had become narrow due to the nasal contracture were improved significantly.
Photos after the surgery
Dr. Kang’s opinion regarding nasal contracture deformity
When I perform surgery on a contractured nose, I often think about the importance of the septal cartilage. If inflammation occursl, but there is a lot of septal cartilage left, the nose tip is less deformed. If this patient had a little more septal cartilage left, it would have been less contractured than its current state, and it would have been easier to lower and maintain it that way.
However, it is not a big problem since our hospital reconstructs the septal cartilage to be sturdy and lowers the tip of the nose.
There are two main things about lowering a contractured nose tip. The first is how much the skin is able to be stretched, and the second is how how strong does the structure need to be in order to lower the nose tip. Especially when you have acute inflammation and a complete collapse of the nasal support structure, like in this case, the skin cannot be stretched a lot, and, if there is not a support structure, it is important to first reconstruct a sturdy structure in order to raise up the foundation and be able to lower the nose.
Today, we learned about reconstructive surgery for a nasal contracture patient, whose septum had almost disappeared. If you are struggling with nasal contracture, I hope you found this article to be of help.
Dr. Chayoung Kang
Director of Noselab Clinic
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