Severe Nose Tip Collapse and Nostril Stenosis After Rhinoplasty

Complicated Revision Rhinoplasty For Alar Collapse, Tissue Necrosis on Nose Tip

Complicated revision rhinoplasty operation was performed using rib cartilage and temporal fascia on the patient who had nostril stenosis, alar collapse, and necrosis of the nasal skin after an operation performed at another clinic. Preoperative and 4-month postoperative images are shown.

According to the information provided by the patient, immediately after the rhinoplasty operation performed at another clinic, there was an infection inside the nose and color changes on the skin of the nose, after the 2nd week, both nasal wings collapsed and indentations started from the skin, despite using a nostril retainer, the left nostril completely closed over time (iatrogenic nostril stenosis) and collapses appeared at the tip of the nose. We planned an open technique revision rhinoplasty operation for the patient. During the operation, temporal fascia and rib cartilages were used to reconstruct the cartilage support tissue and re-support the collapsed areas. In the patient's 4th month photos after the revision nose job, although the nostrils are not completely symmetric; It is seen that it looks much more symmetrical, the stenosis in the left nostril is treated, and the collapse of the nasal wings is eliminated.

Nostril Stenosis

Nostril stenosis refers to the narrowing of the nostrils, which causes permanent nasal congestion in patients, and can lead to breathing difficulties and aesthetic concerns. It is often not easily tolerated by patients and can cause severe breathing difficulties when bilateral. This condition occurs due to excessive removal of nasal tissue, improper healing, or excessive scarring after surgery (you can check the detailed article link about this >> Iatrogenic Nostril Stenosis). 

Nostril Stenosis Symptoms:

• Difficulty breathing through the nose
• Visible narrowing of the nostril openings
• A whistling sound when breathing
• Nasal congestion

Nostril Stenosis Treatment

Laser applications and various surgical procedures can be performed in the treatment of nostril stenosis. Since the chance of partial recurrence of stenosis is high, long-term use of nostril retainers may be required, and it is important to minimize damage to the internal mucosa during the procedure.

Alar Collapse After Rhinoplasty?

After a rhinoplasty operation, the wings of the nose may become softer and prone to collapse. Especially in noses with thick skin, excessive weakening of the alar cartilages may result in alar collapse. In other words, in these surgeries, it is essential to keep the nasal functions as intact as possible by considering "nasal function" on one side and "beautiful appearance in the nose" on the other. Alar collapse occurs when the nostril edges become weak or unsupported, causing them to collapse during breathing. This problem is usually associated with excessive cartilage removal or lack of structural support during rhinoplasty. If there is collapse in the wings of the nose before rhinoplasty, if there is a thick skin structure and soft cartilage structure, weak cartilage support, caution should be exercised during the operation.

Symptoms of Alar Collapse

• Nasal congestion while breathing
• Nostrils visibly collapsed inwards
• Difficulty breathing during exercise or at night

Alar Collapse Treatment

Nasal valve surgery (you can check the detailed article link about this >> Nostril Collapse - Alar Collapse)

Cartilage graft from septum, ear or rib (our patient here used rib cartilages to re-establish the cartilage support structure in the wings of the nose)

External nasal splints (non-surgical and can only be used for temporary treatment)

Tissue Necrosis and Tissue Loss After Rhinoplasty

Tissue necrosis is a rare but serious complication in which the skin tissue at the tip of the nose dies due to insufficient blood supply. There is a rare risk of occurrence after primary rhinoplasty operations. This condition may occur as a result of excessive tissue dissection, excessive electrocautery or radiofrequency application, infection, or too much pressure applied to the skin of the nose after surgery. Smoking and cocaine use, which can reduce blood circulation in the nose or increase the risk of infection after surgery, can also increase the risk of tissue necrosis.

Symptoms of Tissue Necrosis

• Dark discoloration at the tip of the nose
• Severe pain and swelling
• Skin crusting or ulceration
• Foul-smelling discharge

The patient I shared with you here also stated that the above symptoms appeared after the 2nd week after surgery.

Tissue Necrosis After Rhinoplasty Treatment Options

Early intervention is important. The following treatment options are available:,

• Antibiotics to prevent infection
• Wound care with special dressings
• Hyperbaric oxygen therapy
• Reconstructive surgery in severe cases

Prevention of Complications

To prevent the complications listed above after rhinoplasty, careful tissue dissection should be performed, cartilage support in the nose should be protected, and postoperative care recommendations should be taken into consideration. It is important to have regular check-ups with the surgeon who operated on you and to pay attention to your doctor's recommendations.

Search result link where you can find articles prepared by Dr. Murat Enöz about "nostril stenosis" and published on this website (you can also reach previous articles by clicking "more posts" at the end of the page) >> https://www.ent-istanbul.com/search?q=nostril+stenosis

Source links >> Successful management of unilateral nasal vestibular stenosis caused by trauma: A case report - PMC / Treatment strategy for iatrogenic nasal vestibular stenosis in young children - ScienceDirect

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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