Contracted Nose Correction with Costal Cartilage and Acellular Dermal Matrix #ContractedNoseSurgery #RibCartilageRhinoplasty #DermalMatrixRhinoplasty

PH

Developed rhinitis and sinusitis after a nasal bone fracture caused by external impact 10 years ago

1st surgery - 10 years ago, the dorsum was raised with silicone and the nasal tip with ear cartilage  

                     => 4 months later, the silicone was pushed out into the inside of the nose

2nd surgery - silicone replaced 4 months after the 1st surgery  => the silicone became crooked

3rd surgery - silicone removed 6 months after the 2nd surgery

4th surgery - silicone inserted again 6 months after the 3rd surgery

CC

The nasal tip is upturned and the nostrils show; the dorsum is thick.

The dorsum feels heavy, with pressure and headaches. Nasal obstruction is severe on both sides.

P/E

The dorsum is thick and lumpy, and the nose is short and upturned. The nostrils are pulled upward.

The silicone extends up to where the eyebrows begin, and the deformity of the nasal tip is very severe.

As the nasal tip is pulled upward, the nostrils are elongated in an "11" shape.

On both the left and right, there are mucosal adhesions between the septum and the turbinates.

The silicone, capsule, and scar tissue were removed.

The 7th costal cartilage and perichondrium were harvested from below the right chest.

An "L"-shaped framework was built from autologous costal cartilage to secure the desired length,

and the tip cartilages were hung on the end of the "L" framework.

The mucosal adhesions between the septum and the turbinates were released with radiofrequency,

and packing was placed to keep them from adhering again.

In the photo one month after surgery, the nose has lengthened enough that the nostrils are covered.

However, the dorsum is wide and thick, so it still looks swollen and unnatural.

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In the photo 5 months after surgery, the dorsum has slimmed considerably and the bridge has become narrower,

and the nose can be seen to have lengthened further.

At 5 months after surgery, the nasal tip and dorsum have slimmed, and the surgical mark on the columella is barely visible.

Before surgery, the nasal tip was pulled upward and the nostrils were elongated in an "11" shape,

but at 5 months after surgery they look natural.

The nose has lengthened sufficiently and extends straight.

The bridge has also gradually slimmed after surgery, and the height of the dorsum, raised with acellular dermal matrix,

has not decreased much in the 5-month postoperative photo.

Supplementing dorsal height with acellular dermal matrix after removing the silicone and capsule in this way

has the advantage of restoring both height and skin thickness in patients whose skin has thinned.

Over time after surgery, the nose lengthened a little more.

This is thought to be because the swelling and scar tissue decreased, giving the nasal skin some slack.

The length, height, and angles of the nose have become natural.

The adhesions inside the nostrils have also completely disappeared.

The patient reports that nasal breathing has improved considerably and sleep quality has improved.

Contracted Nose Correction with Costal Cartilage and Acellular Dermal Matrix #ContractedNoseSurgery #RibCartilageRhinoplasty #DermalMatrixRhinoplasty