Correction for Patients with Crooked Nostrils and Columella and Severe Nasal Obstruction

We often see patients who say that after rhinoplasty the nasal tip and columella became crooked and nasal obstruction worsened.

Looking inside the noses of these patients, the end of the septum on one side can be seen bulging into the nasal cavity.

Harvesting septal cartilage and attaching it to the lower septal cartilage (caudal septum)

to lengthen the nose or raise the tip, that is, the septal extension graft (SEG), is precisely the cause.

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In a septal extension graft using septal cartilage, the amount of septal cartilage that can be harvested is limited,

so it cannot be placed on both sides. Because it is therefore placed and fixed against the end of the septum on one side only,

it sits slightly off the center of the septum, and the long extension graft, under the

tension of the tip skin, may be pushed backward and bend.

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When the tip cartilages are fixed to it, the tip tends to tilt to one side.

An extension graft that is bent and protruding in this way bulges into the nasal cavity and narrows the nasal passage,

making breathing through the nose much more uncomfortable.

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In addition, if the tip cartilages are fixed too tightly when they are sutured or brought together, the force shifts to one side

and the tip tilts. Also, when the tip cartilages are tied tightly in the middle, they are drawn toward the center

and buckle, which pinches the tip and makes breathing uncomfortable.

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In such cases, removing the septal extension graft resolves the crooked columella and tip and the nasal obstruction,

and repositioning can return the position and shape of the tip to normal.

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After the length and height are adjusted in this way, fixing the tip cartilages to it

makes it possible to adjust the length and height of the tip as well.

However, when the tip cartilages are fixed to the end of an extension graft attached on one side only, as in the illustration,

in an attempt to increase the length and height of the tip, the tip tends to shift to one side.

In such cases, not only do the columella and tip tilt toward that side,

but nostril asymmetry and nasal obstruction also develop.

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P/H - 6 years ago at another clinic: silicone + septal extension graft + ear cartilage graft to the tip. (The bridge and tip were raised.)

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C.C - The patient reported that, from immediately after surgery, a protrusion could be felt at the end of the septum inside the left side of the nose.

Because of this, breathing through the left side of the nose was difficult, and the tip was hard and fixed.

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WW - The patient wanted everything removed so that breathing would be easy, the protrusion would be gone, and the tip would soften.

As for the tip shape, the patient did not want it to spread out too much, as it originally had.

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Surgical plan - Through an open approach, remove all of the silicone, capsule, septal extension graft, ear cartilage on the tip, and so on,

correct the deviation and curvature of the tip, and also correct the pinched tip.

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In the left nostril, the protruding septum can be seen even with the naked eye.

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During surgery, the columella and tip were confirmed to be shifted to the left.

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The septal extension graft that protruded before surgery is gone,

and after surgery the septum is smooth.

P/H - 1st surgery 9 years ago at another clinic: silicone implant for the bridge + ear cartilage strut for the tip (open approach)

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