[Real Case] Revision Rhinoplasty for Short Nose, Upturned Nose, and Retracted Columella

#RevisionRhinoplasty #Columella #NasolabialAngle #UpturnedNose #ShortNose #NoseTip #NasalBridge #ContractedNose #DroopingNoseTip #DeviatedNose #AutologousRibCartilage #AutologousRibRhinoplasty #GangnamAutologousRib #GangnamRhinoplasty #HumpNose #Uber #SeoSeungJo #GangnamRevisionRhinoplasty

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Hello~

💎your beauty universe! I am Dr. Seo Seung-jo, head director of Uber Plastic Surgery :)💎

This time, I would like to review the most common cases that come in for revision rhinoplasty.

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Plastic surgery is also a branch of medicine, so basic diagnosis and surgical planning are approached according to the fundamental methods used in medicine.

However, what makes it slightly different is that surgical planning involves diverse aesthetic standards, so the patient's opinions are reflected more heavily.

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Pre-operative Diagnosis and Planning

This patient underwent rhinoplasty 10 years ago using an implant, ear cartilage, and septal cartilage. However, she experienced an upturned nose tip, retracted columella, and a deviated nasal bridge implant.

Additionally, as time passed, she felt her nose tip was becoming progressively more upturned and visited our clinic out of concern that it might be a contracture caused by inflammation.

Pre-operative Analysis

Let's look at the patient's photos and analyze what the issues are using more objective indicators and my aesthetic standards.

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Looking at the frontal photo,

First, the starting point of the nasal bridge is skewed to the left, making the face look even more asymmetrical.

Second, the nostrils are overly exposed, and the alar base appears flared and drooping.

Third, the philtrum looks long, and the mouth appears protruded.

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Shall we look at the lateral photo?

First, the columella is retracted and the nose tip is short, making the face look compressed.

Second, the alar base is drooping, and the nasolabial folds appear deep.

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We also need to look at the nostril photo.

Fortunately, the asymmetry of the nostrils does not look severe.

Also, since it has been 10 years since the surgery and there are no signs of contracture, the skin condition was judged to be not bad for a revision surgery.

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Many people worry that a shortened nose means contracture,

but if it is not hard or distorted, it is highly likely that there is no contracture.

In addition, understanding the internal condition of the nose is extremely important in rhinoplasty, so a facial CT scan is performed.

Shall we look at the patient's CT together?

Looking at the sagittal view, there are no signs of the implant sliding down to the nose tip, and it is well adhered to the nasal bone.

Looking at the frontal and coronal views, we can see that the nasal septum is severely deviated to the right.

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When projecting the nose tip, especially when lengthening a shortened nose, a septal extension graft method is used.

Therefore, without correcting the deviated septal cartilage, the nose will inevitably become crooked.

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PLAN

Now, let's set up the surgical plan!

Based on our understanding of the pre-operative condition, we need to choose the materials to be used for the rhinoplasty.

Septal and ear cartilage were used in the previous surgery, but the tip lengthening was insufficient, and the remaining septal cartilage is deviated.

Thus, to correct the deviated septum and lengthen the nose, a sturdy cartilage like rib cartilage is required.

So, between donated rib cartilage and autologous rib cartilage, which one is better to use here?

It depends on the pre-operative nose condition and the desired shape, but in this case, I believe that whichever cartilage is used,

the same result can be achieved.

However, it is true that autologous rib cartilage is a better material in many aspects.

Also, the patient wanted to use autologous rib cartilage, so we used it for the nose tip reconstruction.

Of course, we did not discard the previously used cartilage.

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Comparison: Before Surgery / 1 Week Post-op

First, let's look at the 1-week post-op photo to see what changes have occurred.

Looking at the lateral photo, the overall three-dimensionality of the face has been revived. The position of the nasolabial angle and the alar height have been lowered, eliminating the alar drooping.

The nasolabial folds have also improved due to the nose tip extension.

Of course, due to overall swelling, the glabella looks high, and the nose tip appears slightly upturned.

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Shall we look at the frontal photo?

The deviation of the nasal bridge has been improved, and nostril exposure has significantly decreased.

Looking at the basal photo, the ratio between the nostrils and the nasal lobule has improved, and the alar flaring is slightly better.

Most people think that raising the nose tip will greatly reduce the alar width,

but in reality, the alar width does not decrease that much. Rather, the effect of it appearing narrower due to improved proportions is much greater.

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Post-op / 2 Weeks / 2 Months

Many people are curious about how the nose changes 2 months, 1 year, and 2 years after surgery.

The most changes occur up to 2-3 months, and after that, as long as the support of the tip cartilage is well maintained,

not many significant changes will occur.

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From the front, as the swelling subsides, the thickness of the nasal bridge and tip has become slightly thinner, the nose tip has come down a bit,

and as the nasolabial angle settles in, the nostril exposure has decreased a bit more.

As a result, the asymmetry of the nostrils also looks better.

As the swelling on the side subsides, the height has slightly lowered, and the nostril pulling has become more natural.

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Looking from the basal view, the swelling in the columella has subsided, and the redness at the nose tip has improved.

When a short nose is significantly lengthened, initial redness at the nose tip is inevitable, but it improves over time.

However, if the skin was very thin before surgery or if the nose tip was lengthened excessively, cartilage visibility may occur later on.

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Before Surgery / Day 7 / 2 Weeks / 2 Months

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In this post, we reviewed the most common cases that come in for revision rhinoplasty. We will continue to provide more detailed information through various case reviews in the future. If you have any questions, please leave a comment and we will answer them.

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