Bulbous nose correction and lowering the columella

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a rhinoplasty case of a patient who was concerned about a retracted columella, bulbous nose, and a blunt, drooping tip.

The patient had previously undergone alar reduction surgery and desired a natural yet well-defined nose.

Let us analyze the patient's preoperative condition in detail:

Front view:

Front view

• Nasal tip appears bulbous and broad

• Nostrils appeared small and asymmetrical

• Nasal width appeared wide

Profile view:

Profile view

• The nasal tip was drooping

• The columella was retracted, making the alae appear more prominent

• Long philtrum and signs of a protruding mouth

Oblique view:

Oblique view

• The flattened, spread appearance of the nose was noticeable

• Drooping and bluntness of the nasal tip were clearly visible

Nostrils:

• The nostrils were significantly small due to previous alar reduction surgery

• Nostril asymmetry observed

1. Narrow the nasal width

2. Maintain or improve the current degree of nostril show

3. Make the midface appear shorter

4. Lower the radix

5. Make the philtrum appear visually shorter

6. Create a straight bridge line

7. Correction of upturned nose

8. Achieve a natural yet well-defined look

Taking into account the patient's condition and requests, the following surgical plan was established:

a) Septal extension graft using autologous rib cartilage

b) Bulbous nose correction surgery

c) Lowering the columella

d) Nasolabial angle correction

e) Removal of foreign material (hyaluronic acid filler) from the nasal bridge and lowering the radix

a) Autologous rib cartilage harvest and grafting:

• Through a 2.5 cm incision at the patient's right 8th rib cartilage, approximately 4 cm of rib cartilage was harvested and used for septal extension, lowering the columella, and nasolabial angle correction.

b) Septal extension graft:

• Autologous rib cartilage was used to extend and reinforce the septum.

• This increased structural support for the nasal tip and corrected drooping.

c) Bulbous tip correction:

• A portion of the subcutaneous tissue in the nasal tip was removed, and the lower lateral cartilages were repositioned and sutured.

• The nasal tip contour became natural and was elevated moderately to achieve overall facial balance.

d) Lowering the columella and correction:

• Using autologous rib cartilage, the retracted columella was lowered and reinforced to improve balance with the alae.

• This produced the visual effect of shortening the philtrum.

e) Nasolabial angle correction:

• To improve the appearance of the protruding mouth, autologous rib cartilage was used to correct the nasolabial angle.

f) Nasal bridge augmentation and radix adjustment:

• Foreign material (hyaluronic acid filler) was removed from the nasal bridge, the radix was lowered, and an implant was placed.

All procedures were performed using a closed approach, completing the surgery without external scars.

Comparing photos taken immediately after surgery on day 0 shows the following improvements: Photos taken immediately after surgery show swelling and may differ from the final result.

Front view:

• The nasal tip, which once appeared blunt and wide, was refined into a delicate and natural shape.

• The nasal width was narrowed, giving an overall slimmer appearance.

• Nostril asymmetry was improved, and natural nostril show was maintained.

Profile view:

• The drooping nasal tip was appropriately elevated, improving overall balance.

• The retracted columella was brought downward, improving its harmony with the alae.

• The philtrum appears visually shorter, and the appearance of the protruding mouth was softened.

Oblique view:

• The previously flattened nasal contour was refined into a slim, sophisticated shape.

• Nasal tip projection improved, enhancing overall facial harmony.

• A natural straight bridge line was established.

Nostrils:

• While maintaining the small nostril size resulting from previous surgery, the overall shape was improved.

• Asymmetry was substantially improved, presenting a balanced look.

This case was a complex rhinoplasty where the patient's diverse requests were addressed despite the constraints imposed by previous alar reduction surgery. By lowering the columella, overall nasal balance was improved, and harmonious results were achieved by simultaneously correcting the nasal tip, augmenting the bridge, and reducing nasal width.

In particular, improving the overall shape of the nose while maintaining the nostril size that had already been reduced from prior surgery was challenging. This was achieved by maximizing the advantages of the closed approach and applying delicate surgical techniques.

The natural yet well-defined look desired by the patient was achieved, and overall facial balance was improved along with the visual shortening of the midface.

I hope this case offers encouragement to those concerned about a retracted columella, bulbous nose, or a blunt, drooping tip. Even with previous surgical history or complex issues, satisfying outcomes can be achieved with proper surgical planning and technique.

NOSELAB provides customized surgical plans for each patient based on up-to-date medical techniques and extensive clinical experience. If you are considering rhinoplasty, we encourage you to consult with a specialist to find the approach best suited to you.

NOSELAB is here to help you achieve a healthy, aesthetically pleasing nose. Thank you.

Q1: What are the effects of lowering the columella?

A1: Lowering the columella improves balance between the alae and the columella and makes the philtrum appear visually shorter. It also corrects a drooping nasal tip and enhances overall nasal balance.

Q2: Can I undergo additional rhinoplasty if I have previously had alar reduction surgery?

A2: Yes, it is possible. However, surgical planning must be conducted carefully considering the conditions left by previous surgery. It is important to determine the appropriate surgical approach through consultation with an experienced specialist.

Q3: What are the advantages of a closed rhinoplasty approach?

A3: A closed rhinoplasty approach leaves no external scars, and the recovery period is relatively short. It also allows for delicate corrections while causing less structural disruption to the nose.

Q4: When can I return to daily activities after surgery?

A4: Recovery varies by individual, but patients can generally return to daily activities after 1-2 weeks. Achieving complete recovery and the final result takes about 3-6 months.

Q5: Which is better, autologous cartilage or artificial implants?

A5: Both options have their pros and cons. Autologous cartilage carries no risk of rejection and yields natural results, but requires a harvesting procedure. Artificial implants are convenient to use, but there may be foreign body reactions. The appropriate method should be selected according to the patient's condition and preferences.

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