Hello, this is Dr. Chayoung Kang, Director of Noselab Rhinoplasty Clinic. This case involves a patient who underwent her 3rd revision rhinoplasty over a span of 23 years. The main concerns included a bulbous nose, retracted columella, protruding mouth, and asymmetrical nostrils, worsened by previous surgeries and an accident after the second procedure.
Patient’s Medical History for Revision Rhinoplasty
- 23 years ago: Initial rhinoplasty using ear cartilage and silicone implants.
- 20 years ago: Second surgery, also with ear cartilage and silicone, which resulted in a contracture due to an accident.
- 2011: Third surgery using autologous rib cartilage, silicone, and septum reconstruction.
Preoperative Analysis before Revision Rhinoplasty
Frontal View
From the front, the patient’s nose appeared wide and blunt with significant nostril asymmetry. The retracted columella was barely visible, making the nose tip look bent to the left. The right side of the nose also had a pinched appearance. Additionally, the patient had a long philtrum, contributing to the unbalanced appearance of the nose and mouth.
Side Profile
The patient’s side profile revealed a protruding mouth and a blunt nose tip. The retracted columella was not visible at all, which further emphasized the unrefined nature of the nose tip.
45-Degree Angle
At a 45-degree angle, the nose tip appeared depressed, and the retracted columella became more apparent. The long philtrum and mouth protrusion added to the imbalance of the overall facial profile.
Detailed Surgical Procedure
Autologous Cartilage Transplant
The first step in the surgical correction involved harvesting cartilage from the patient’s rib and ear. This cartilage was used to reconstruct areas of the nose that required reinforcement, particularly around the nose tip and sides, to restore structural stability.
Septal Extension Graft
Next, a septal extension graft was performed using the harvested rib cartilage. This helped strengthen the nose tip’s support and contributed to improving the overall shape of the nose, addressing the patient’s concerns about the retracted columella.
Nose Tip and Columella Correction
The nose tip, which was previously blunt and undefined, was carefully reshaped to create a more delicate and natural appearance. Simultaneously, the retracted columella was raised using rib cartilage, ensuring it became visible without elongating the nose excessively. Adjustments to the nasolabial angle were also made to ensure the result remained harmonious with the rest of the face.
Nasolabial and Nostril Asymmetry Correction
Nasolabial Angle
The nasolabial angle, which refers to the angle between the nose and the upper lip, was adjusted to correct the protruding mouth and create better harmony between the nose and lips. This adjustment played a key role in achieving a more balanced facial appearance, which was one of the patient’s primary goals.
Nostril Reconstruction
The patient’s nostrils were significantly asymmetrical before the surgery, with the right nostril appearing much smaller than the left. Using cartilage repositioning and alar reconstruction techniques, the nostril asymmetry was corrected, creating a more balanced and symmetrical nose shape.
Before and After Comparison
Frontal View
The patient’s nostrils were significantly asymmetrical before the surgery, with the right nostril appearing much smaller than the left. Using cartilage repositioning and alar reconstruction techniques, the nostril asymmetry was corrected, creating a more balanced and symmetrical nose shape.
Side Profile
From the side profile, the mouth protrusion was significantly reduced, which improved the overall facial balance. The nasolabial angle was adjusted to create a smoother transition between the nose and the lips. The retracted columella, which was previously hidden, was lowered, resulting in a more refined and prominent nose tip.
Nostril View
When viewed from below, the nostrils displayed a much more symmetrical appearance. The previously retracted columella was straightened, eliminating the tilted look of the columella that was present preoperatively.
Post-Surgery Results
Following the surgery, the patient experienced significant improvements in both the aesthetics and function of their nose. The use of autologous cartilage, along with the closed rhinoplasty approach, ensured a faster recovery time and avoided external scars, which is particularly beneficial for patients who have undergone multiple surgeries. The nose now appears more balanced, symmetrical, and natural, while the facial harmony has been restored.
Benefits of Closed Rhinoplasty
The closed rhinoplasty technique used in this case allowed for minimal visible scarring, as all incisions were made inside the nostrils. This method also typically results in a shorter recovery period compared to open rhinoplasty, making it an ideal option for patients seeking revisions or those who are concerned about scarring.
Improved Facial Harmony
The correction of the retracted columella, nostril asymmetry, and protruding mouth helped to restore overall facial balance. By making precise adjustments to the nasolabial angle and the nose tip, Dr. Kang was able to create a natural, aesthetically pleasing nose that aligned with the patient’s desires.
Final Thoughts and Expert Commentary by Dr. Kang
This case demonstrates the importance of an experienced surgeon when dealing with complex rhinoplasty revisions. Dr. Kang’s ability to correct multiple issues such as a retracted columella, nostril asymmetry, and bulbous nose highlights the advanced skills required to achieve a natural result without elongating the nose or creating an unnatural appearance.
Dr. Kang emphasizes the significance of understanding each patient’s unique needs and delivering customized solutions. Through a delicate balance of lowering the columella and adjusting the nasolabial angle, the result was not only a visible columella but also a harmonious look that complemented the patient’s facial features. This case shows how revision rhinoplasty can solve functional and aesthetic challenges, ultimately delivering patient satisfaction.
For patients seeking expert rhinoplasty, Noselab Rhinoplasty Clinic remains a leader in closed rhinoplasty techniques, helping patients achieve the natural, refined results they desire without the worry of external scarring.
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