Nasal obstruction after rhinoplasty

No matter how beautiful the nose may look, it is really depressing and embarassing if the patient cannot breathe well. Unfortunaely, nasal obstruction after rhinoplas
ty is pretty common. These unexpected functional problem needs a lot of attention for proper treament.

Finding out an exact place of obstructon is most important for proper treatment. However, this is complicated due to altered shape, distorted anatomy, lack of surgery information, and scar formation.
Common reasons for obstruction after rhinoplaty includes;
1) deviated septum (not corrected or newly developed)
2) internal valve stenosis after hump removal
3) collapsible lateral nasal wall due to weakened cartilage
4) narrowing of nostril due to thickend or deviated septal grafts
5) nostril stenosis due to scar
6) saddle nose with collpase of nasal cartilage
7) nasal cavity mucosal problem (stenosis, turbinate hypertrophy, mucosal loss...)

Treatment follows complete analysis of the site and etiology of obstruction. Various techniques including septal reconstruction, spreader graft, butterfly graft, alar batten graft, flaring suture, and composite graft with scar removal helps to solve this problem.

In rhinoplasty, function of the nose should not be sacrificed for aesthetic purposes. Function and shape of the nose are good friends who can go together.

Correction of easily collapsible nasal wall developed after rhinoplasty

Comments

Deviated & hump nose correction

This lady in below photos had nasal deviation, hump nose, and tip ptosis with breathing difficulty. Septum was corrected first, and this made the lower 2/3 of the nose straight. Hump was not resected but rasped with Piezotome and this did not breach the keystone area, which made spreader grafts unnecessary.Bilateral osteotomies with Piezotome made her bone straight. Together with septum correction and effective osteotomies, her nose became straight from the frontal view. Tip was modified with sutures and onlay graft only. No strut or septal extension graft was used and this made the tip soft even after considerable amount of rotation and projection increase. Radix was augmented with bruised cartilage. Overall, she could breath much better after surgery and her nose became more harmonious and feminine.

key to rib cartilage use in rhinoplasty

I had the joy to guest edit a special issue ' The key to costal cartilage in rhinoplasty' in journal 'Plastic and Aesthetic Research'. This special issue covers all issues of rib cartilage use in rhinoplasty; cutting edge techniques of harvesting and carving, application of rib cartilage in primary and revision rhinoplasty, practical points for proper preoperative and postoperative care, and diced cartilage and homologous cartilage applications. I invited world renowned rhinoplasty surgeons who are specialists in dealing with rib cartilage use. I hope rhinoplasty surgeons who wants to use rib cartilage in their practice will benefit from the wisdom of the experts.

Creating more feminine nose

The lady in below photos visited my clinic for rhinoplasty. She wanted to have more feminine nose instead of her muscline nose. She had a long nose with slight bump on the dorsum, overprojected, slightly bulbous and droopy tip, and slighly wide dorsum. Surgery was focused on creating more feminine look: hump removal, narrowing the bony dorsum with osteotomies, tip volume reduction, decreasing tip projection, and slight cephalic rotation. Photos taken 2 weeks after surgery (because she returnd back to her country after surgery) shows changes on the dorsum and the tip. Dorsum became slender with creation of smooth brow-tip aesthetic line. Tip was refined with volume reduction, slight underprojection, and cephalic rotation. Although the changes are not radical, her nose looks more feminine.

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