[Real Case] Autologous Rib Cartilage Revision Rhinoplasty, Deviated Nose, Columella Correction

#AutologousRibCartilage #RevisionRhinoplasty #AutologousRib #DeviatedNose #ColumellaCorrection #ProtrudingMouthNose #AlarReduction #HumpNose #ShortNose #LongNose #DeviatedSeptum #Weverse #SeoSeungJo #ShimJungHwan #ParkSunHee

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Hello~

💎your beauty universe! This is Dr. Seo Seung-jo from Weverse Plastic Surgery :)💎

This time, I would like to review a case where severe contracture occurred after rhinoplasty.

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First, we should look at the patient's medical history.

Unfortunately, the patient had already undergone three previous nose surgeries.

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1. About 20 years ago, she had rhinoplasty using only a silicone implant.

2. One year later, she experienced symptoms of the silicone moving, so the implant was replaced.

3. Six months after that, contracture symptoms occurred, so the silicone was removed and reconstructed using rib cartilage and buttock dermis.

However, the reconstruction was not successful.

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Preoperative Diagnosis and Plan

1. The patient stated,

"Due to the failure of three surgeries, I hadn't even thought about revision surgery for 20 years.

However, I visited the clinic this time to see if surgery is possible once again,

and I want to make my pinched nasal tip and nostrils somewhat normal, even if not completely perfect."

2. Diagnosis

Let's diagnose the current condition through the patient's photos and CT scans.

This case can be considered a typical contracture case.

Many people think that inflammation starts from the silicone, but in most cases, it begins at the nasal tip, especially the columella and nasal septum,

and the symptoms tend to appear more severely.

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Looking at the frontal photo,

due to the contracture, the nasal tip is pinched, the boundary with the alar base has become severe, the philtrum looks longer, and the overall axis of the nose is deviated.

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Looking at the lateral photo,

you can see that severe contracture has occurred to the point where it feels like the nasal tip and columella have been sliced off by something.

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Looking at the nostril (basal) photo,

you can see that the nasal tip cartilage is weakly pinched, the columella has become thin, and the shape of the nostrils is abnormally deformed.

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Let's look at the CT scans.

In the coronal view, the nostrils have become extremely small, and we could confirm that the nasal tip is filled with severe scar tissue.

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Plan

First, although autologous rib cartilage was used previously, it cannot be used as a strut,

and due to the severe contracture, we decided to harvest new autologous rib cartilage.

The most important part of a contracture nose is whether the skin and the nasal mucosa can stretch.

Fortunately, since it had been 20 years since the last surgery, there was more leeway in the skin and mucosa than expected,

so I didn't think an intranasal skin graft or a secondary surgery would be necessary.

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Lastly, there was the question of whether the use of silicone was absolutely necessary to raise or smooth the nasal bridge...

Based on the lateral photo, the bridge height was not very low, so we decided to create the bridge line using rib cartilage and donated dermis (Megaderm).

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Comparison Before Surgery & 1 Week After Surgery

Looking at the frontal photo, the nasal bridge and tip have become fuller, and the deviation seems much improved.

Also, the boundary between the nasal tip and alar has become very natural.

However, while the nostril exposure has become natural, they actually seem to be a bit more visible.

The reason for this can be seen in the lateral photo.

As the depressed columella was brought out, the nasolabial angle increased, and since only one week has passed since the surgery, the frontal nostril exposure appears prominent.

However, the overall bridge line has improved, and you can see that the philtrum length has also shortened.

Looking at the nostrils, the shape has improved significantly, but you can see that the columellar wound is not in great condition due to excessive lengthening.

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2 Weeks & 2 Months After Surgery

It would be best to check the condition of the columella first.

After 2 weeks, you can see that the columellar wound has improved significantly. I believe this is the greatest advantage of autologous rib cartilage.

When the skin is significantly lengthened, if the tissue under the skin is donated rib cartilage or artificial cartilage,

the skin wound does not heal quickly.

However, with autologous rib cartilage, wound healing becomes much more stable.

Looking at the frontal and lateral views at 2 weeks, you can see that the nasal tip has dropped slightly and the swelling has subsided, making it look much more natural.

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Now, let's check the condition after 2 months.

The dermis grafted onto the bridge has absorbed slightly, making it thinner overall, but since we used about 1.5mm of dermis,

it is confirmed that there is not much change in height from the lateral view.

Also, as the nasal tip has settled, you can see that the nostrils are less visible and look more natural.

One regretful aspect is that because the lacking soft tissue of the columella was reinforced with rib cartilage, the nostrils look a bit narrow.

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Pre-Op / 7 Days / 2 Weeks / 2 Months

In this post, we reviewed a typical case of a contracture nose.

The most important parts of contracture nose reconstruction seem to be the reconstruction of the strut and the condition of the skin.

In this case, the skin condition was better than expected, allowing for a successful reconstruction.

If you have any questions, please leave a comment and I will answer them.

If you want a quick consultation?

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