NYC Man Thankful for Nose Reconstruction After Devastating Effects of Rare Autoimmune Disorder

Josh Kane is thankful for the life he lives. Josh works in the bustling world of finance in New York City (NYC). His days are filled with client meetings and high-level presentations, both requiring a great deal of face time. Outside of work, Josh and his family are active in their community — from sports to church and everything in between.

“My career, family and social life requires me to engage with many people,” says Josh. “It’s always been an important part of who I am.”

In 2019, various unexplained nasal symptoms — sinus infections, shortness of breath, nosebleeds — began to plague him. Over 18 months, Josh began to have throat, kidney and lung issues too. And, his nose ultimately disintegrated — making it look sunken in, shortened and very deformed.

After seeing a plethora of doctors in NYC, Josh was diagnosed with granulomatosis with polyangiitis (GPA), a rare autoimmune disease characterized by inflammatory masses called granulomas that form in the blood vessels and organs. GPA tends to affect the respiratory system and kidneys the most and causes inflammation in the blood vessels which can cause them to swell, break and bleed. It can also cause scarring that restricts blood flow through the vessels, depriving the tissues of oxygen and nutrients leading to severe complications that compromise the nasal structure causing deformities. 

“The effects of GPA were absolutely devastating,” recalls Josh. “I was left with a jarring look that was psychologically impactful; it incapacitated my work and family life. I didn’t want my kids to be embarrassed by what others might say.”

A regimen of chemotherapy, dialysis and medications were prescribed to suppress Josh’s immune system and kill off the proteins that were attacking his system. This put GPA in remission, but the damage to his nose wasn’t reversible.

Halfway through his treatments, Josh saw plastic surgeons in NYC and zig-zagged around the country seeking treatment for his nose. No one gave him much hope or a solid plan. Many were afraid of reigniting GPA and Josh’s body rejecting a reconstructed nose. “My options seemed complicated, expensive and without a satisfactory conclusion,” says Josh.

During his search, he came across an article on a GPA patient treated by Michael Fritz, MD, a facial plastic and reconstructive surgeon at Cleveland Clinic.

“Dr. Fritz had extensive experience and unbelievable results. That gave me great hope,” recalls Josh.

In the fall of 2022, Josh flew to Cleveland for a consultation with Dr. Fritz.

“GPA is an uncommon disease which makes it challenging to diagnose. By the time the disease is treated and patients are in remission, the nasal damage is done, leaving those affected with permanent and severe external deformity which contributes to an emotionally crippling aftermath,” says Dr. Fritz. “I have had pretty extensive experience in GPA nasal reconstruction at Cleveland Clinic, because we have one of the premier rheumatologic centers that manages this disease. We therefore see a lot of affected patients, so despite the complexities of management, I knew I could give Josh a nose that would be aesthetically pleasing and help him regain self-confidence.”

Before Dr. Fritz could operate, Josh needed to be in remission in order to prevent a GPA flareup. Dr. Fritz collaborated with Cleveland Clinic rheumatologists to ensure he was in remission.

“Dr. Fritz couldn’t have been more empathetic, understanding and knowledgeable. I felt hope and relief that I hadn’t felt in years.”

“Dr. Fritz couldn’t have been more empathetic, understanding and knowledgeable. I felt hope and relief that I hadn’t felt in years,” says Josh.

Soon after his appointment with Dr. Fritz (in 2022), Josh had nasal reconstruction surgery. During the four-hour surgery, Josh’s rib bone and cartilage were harvested and used to reconstruct the L shaped section of the nasal septal cartilage (called the L-strut) which provides support for the nasal bridge and tip. This provided Josh with a normal nasal appearance, airway support and also resists tissue tension and scarring to prevent postoperative collapse or deviation of the nose.

“The L-strut was placed in a precise pocket created through incisions at the end of the nostrils and continued over the nasal bridge. Since there was excessive scar tissue present, extensive scar release was necessary to allow the skin to drape over the structure,” explains Dr. Fritz.

The rib bone was sculpted to allow it to precisely fit upon and integrate with Josh’s own nasal bones, forming a very strong, fused construct that supports the nasal tip and bridge. After the tip cartilages were secured to the construct, additional rib cartilage grafts were placed to give the nasal tip more normal appearance and angles.

“An advantage of the cartilage component of the reconstruction at the nasal base is that Josh’s own nasal tip cartilages can be secured easily to this construct to achieve the most natural angles and shape,” explains Dr. Fritz.

Once the surgery was complete, Josh spent a few hours in recovery and was discharged. He flew back to NYC the next day and had a 10-day recovery at home which included taking antibiotics and daily communication with Dr. Fritz.

Complications from GPA, a rare autoimmune disease, resulted in external deformities to Josh Kane’s nasal structure (left), which were corrected following nasal reconstruction surgery at Cleveland Clinic (right).

One month later, Josh had a follow-up appointment to remove stitches and to ensure healing was going well.

“Josh’s life was transformed with one surgery. That’s why I love doing this procedure. If done correctly, you can really restore a normal appearance to these patients who have essentially lost their identity through the disease process and are reminded every day of what they’ve gone through when they look in the mirror. This is one of my favorite fusion points of reconstructive and cosmetic surgery” says Dr. Fritz. “Josh was one of my most appreciative patients, which really pulled at my heartstrings.”

The L-strut took a few months to fully stabilize and about a year to completely heal. Josh doesn't require any further medical care for his reconstructed nose.

“This disease has been challenging and paralyzing. I was fortunate to be under Dr. Fritz’s care. He was kind and empathetic. The way he transformed my life was nothing short of miraculous,” says Josh. “Dr. Fritz and Cleveland Clinic made everything simple and the care they gave me was utterly amazing. There are no words to describe how thankful I am.”