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Two-stage revision cartilage septorhinoplasty in an Asian female patient with severe short and saddle-nose: a case report of difficult revision rhinoplasty

  • Beta Subakti Nataatmadja ,
  • Loelita Marcelia Lumintang ,
  • Nyoman Bayu Widiartha ,
  • Nyoman Wawan Tirtha Yasa ,
  • Sang Nyoman Suriana ,


Abstract

Background: Iatrogenic short-nose and saddle-nose deformities due to previous alloplastic implants remain the most challenging secondary rhinoplasty, particularly among Asian patients. Cartilage framework reinforcement, dorsal augmentation, sufficient nasal tip projection, and proportional nasal length are considered essential for Asian features. This study aimed to elaborate on full rib and ear cartilage revision rhinoplasty in a patient with those problems.

Case Presentation: A difficult case of a 31-year-old female with short-saddle-nose deformity due to infected silicone implant rhinoplasty is presented. A history of nose filler and thread lift was also reported. We noted a short and under-projected nose, indented scarring, dorsal irregularities, retracted columella, severe septal losses, and high trans-columellar incision scars. We conducted two stages of revision: (1) Secondary septorhinoplasty with the seventh costal graft and right concha cartilage, then alar-plasty and (2) Tip-plasty and columellar shield graft with left concha cartilage. Anatomic improvements, complications, and patient satisfaction responses were documented. The improvement of nasal length (39-46-48 mm), nasal tip projection index (0.5-0.59-0.63), nasofrontal angle (150-137-137°), nasolabial angle (117-85-93°), columella-lobular angle (60-45-42°), columellar show (0-0.5-2 mm), and alar flare (4.5-2.6-2.3 mm) on the pre-operative, first, and second stage were noted. No sign of significant absorption and wrapping was observed in both stage.

Conclusions: Short and saddle-nose deformity is considered one of the most challenging issues in rhinoplasty surgery. This finding is expected to create grounded perspectives among the young surgeons, also well-balanced and sensible beliefs on the final results among the patients.

Keywords: Asian Nose Ear Cartilage Revision Septorhinoplasty Rib Cartilage Saddle-Nose

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How to Cite

Nataatmadja, B. S., Lumintang, L. M., Widiartha, N. B., Yasa, N. W. T., & Suriana, S. N. (2022). Two-stage revision cartilage septorhinoplasty in an Asian female patient with severe short and saddle-nose: a case report of difficult revision rhinoplasty. Bali Medical Journal, 11(3), 2033–2042. https://doi.org/10.15562/bmj.v11i3.4094
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Beta Subakti Nataatmadja
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Loelita Marcelia Lumintang
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Nyoman Bayu Widiartha
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Nyoman Wawan Tirtha Yasa
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Sang Nyoman Suriana
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