Multimodal Salvage Protocol for the Treatment of Severe Post-Rhinoplasty 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, while 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 approximately three 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 fifteen prior rhinoplasties. After Stage 1, bilateral airflow was clinically improved and the vestibular tissue was softer and better perfused on examination at three months. Stage 2 employed a philtral advancement flap, costal and auricular cartilage grafts, and a buccal mucosal graft. At more than three 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.