The patient, a male from Germany, presented with a history of three previous rhinoplasty operations that failed to achieve both aesthetic harmony and functional balance. He exhibited a crooked nose with significant asymmetry and compromised nasal support. In addition, the patient’s extremely thick skin presented a considerable surgical challenge, particularly in defining the nasal tip and maintaining long-term refinement.
Preoperative Evaluation
Clinical examination revealed structural collapse in key nasal support areas due to prior surgeries. The skin envelope was fibrotic and poorly redraped over the framework, limiting projection and definition. As the patient had undergone multiple previous interventions, native septal and auricular cartilage sources were exhausted, necessitating the use of allogenic rib cartilage grafts to rebuild the nasal framework.
Surgical Technique
A fourth revision rhinoplasty was planned and performed by Prof. Dr. Murat Songu. The procedure focused on restoring midline alignment and rebuilding nasal support with allogenic rib cartilage to provide strength and longevity. The surgeon meticulously corrected residual deviations, reconstructed the tip support complex, and reshaped the nasal dorsum while accounting for the heavy, sebaceous skin envelope typical of Nubian nasal morphology.
Given the patient’s prior scar tissue and thick skin, a conservative approach was used to avoid vascular compromise while ensuring stable projection. Precise suturing techniques were applied to define the nasal tip within the limitations of the soft-tissue thickness.
Postoperative Course and Results
In the early postoperative period, the nasal dorsum and tip demonstrated improved alignment and definition. The crookedness and asymmetry were successfully corrected, and nasal balance was restored. Despite the challenges posed by thick skin, the structural enhancements achieved with allogenic rib cartilage provided lasting support and projection.
The before–after images highlight a significant improvement in nasal straightness, tip symmetry, and overall harmony with the facial profile.
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