Multimodal Salvage Protocol for the Treatment of Severe Postrhinoplasty Nasal Vestibular Stenosis: A Case Report.

Abstract

Severe nasal vestibular stenosis is an increasingly recognized iatrogenic complication of cosmetic rhinoplasty. Multiply-revised cases are particularly difficult to manage because previous procedures may compromise the vestibular microcirculation, whereas prolonged stenting alone risks ischemic restenosis. We describe an individualized, staged multimodal salvage approach and illustrate it in a single patient. Stage 1 reopened the obstructed vestibule with scar excision, a local skin flap, and a custom stent, followed by ∼3 months of cold atmospheric plasma (CAP) and monthly intralesional platelet-rich plasma (PRP) intended to condition the scar bed and improve tissue pliability. Stage 2 provided definitive aesthetic reconstruction tailored to the anatomical defects, supported by a 12-month adjunctive regimen of tapered nasal stenting, peri-incisional PRP, a CAP cycle alternating antimicrobial and wound-healing modes, and intralesional triamcinolone acetonide at escalating concentrations (5-40 mg/mL). The patient was a 27-year-old woman with bilateral vestibular stenosis and complete left nostril obstruction after 15 previous nasal procedures. After Stage 1, bilateral airflow was clinically improved and the vestibular tissue was softer and better perfused on examination at 3 months. Stage 2 employed a philtral advancement flap, costal and auricular cartilage grafts, and a buccal mucosal graft. At more than 3 years, nasal airflow and aesthetic contour remained stable on clinical assessment, with no recurrence of stenosis and no further stenting. This single case suggests that a staged surgical strategy combined with a structured biologic and stenting regimen may be a useful salvage option; further cases and objective functional assessment are required to confirm its value. Level of Evidence: 4 (Therapeutic).