Revision rhinoplasty methods for correcting a short, upturned nose

Hello.

I am Dr. Peter C. Kang, medical director.

The patient I am introducing today had previously undergone rhinoplasty.

At that time, cartilage suturing using ear cartilage was performed on the nasal tip, and an implant-free rhinoplasty was performed on the nasal bridge. Over time, however, the nasal bridge became excessively low, prompting the patient to receive hyaluronic acid filler injections.

Even after the filler injections, the overall shape remained unnatural, and the patient experienced discomfort from nasal obstruction that developed after the surgery. The patient visited NOSELAB to correct the short nose, upturned nose, and pinched nose.

Let us analyze the patient's condition in detail:

Front view:

Front view

• Excessive nostril show with asymmetry

• Deviated nasal bridge appearing blunt and widened due to filler

• Findings of pinched alae

• Upturned appearance

Profile view:

Profile view

• High radix

• Excessive nostril show visible on the profile view

• Irregular nasal bridge

Oblique view:

• Injected filler clearly visible along the nasal bridge

Oblique view

• Cartilage show-through visible

• Unnatural overall contour (side effect of cartilage suturing)

Nostrils:

• The columella tilts to the left

• Prominent nostril asymmetry

• Cartilage protruding inside the right nostril

• Right ala appearing pinched

Patient's main requests:

1. Implant-free approach after foreign material removal

2. Lowering the alae

3. Relief of nasal obstruction

4. Correction of the protruding cartilage inside the right nostril (side effect of cartilage suturing)

5. Correction of the pinched and upturned appearance

a) Foreign material removal:

• Filler, AlloDerm, and nylon sutures in the nasal bridge were all carefully removed.

b) Autologous rib cartilage harvest and grafting:

• The patient's rib cartilage was harvested to secure an adequate amount of cartilage required for reconstruction.

• This was used to naturally augment the nasal bridge and reinforce the structure.

c) Septoplasty and septal extension:

• The septum, which was deviated to the right, was straightened.

• Septal extension was performed to correct the short nose.

• Septal extension increased structural support and improved the overall shape.

d) Nasal bridge augmentation:

• Autologous rib cartilage was used to naturally augment the nasal bridge without an artificial implant.

e) Cartilage suture restoration:

• The existing nylon sutures were removed, and the cartilage was repositioned and sutured using a new technique to improve its shape.

f) Inferior turbinate reduction:

• Submucosal resection of the inferior turbinates using a radiofrequency device was performed to improve nasal obstruction.

The entire procedure was performed via a closed approach, leaving no 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:

• Excessive nostril show has been naturally reduced.

• Nostril asymmetry improved significantly.

• The deviated, blunt nasal bridge has become straight and natural.

• The pinched appearance of the alae was improved, achieving a natural look.

• The upturned appearance was improved.

Profile view:

• The radix starting point was naturally adjusted.

• The previously uneven nasal dorsum now displays a smooth, gentle line.

• The improved shape created a harmonious change in the overall profile.

Oblique view:

• The unnatural contour caused by filler visibility was improved.

• The overall line has become smooth and natural.

Nostrils:

• The columella, which was tilted to the left, was straightened.

• Nostril asymmetry improved significantly.

• The cartilage protrusion inside the right nostril was corrected, restoring a natural contour.

This case demonstrates the resolution of complex issues that can arise after cartilage suturing and filler injection in revision rhinoplasty. In particular, securing structural stability at the nasal tip while creating a natural contour through cartilage suture restoration is notable. Excessive cartilage suturing was the underlying cause of the pinched nose, and correcting this area led to improvement.

Foreign material removal and reconstruction using autologous rib cartilage were suitable choices for achieving a stable long-term result. Using autologous tissue minimized the risk of rejection and provided an adequate volume of cartilage to enable complex reconstructive surgery. Strong septal extension with autologous rib cartilage played an essential role in correcting the short, upturned nose.

Improving nasal obstruction through septoplasty and inferior turbinate reduction is significant not only aesthetically, but also functionally. This highlights the value of specialized expertise as a board-certified otolaryngologist.

An implant-free approach allowed us to achieve a natural outcome, and lowering the radix starting point improved the overall facial balance.

I hope this case offers reassurance to those troubled by unsatisfactory outcomes following cartilage suturing. In complex revision cases, selecting a surgeon with extensive experience and clinical expertise is vital.

Based on my anatomical expertise and extensive surgical experience as a board-certified otolaryngologist, I provide surgical plans tailored to each individual patient. Through a comprehensive approach that considers both aesthetic and functional improvements, I strive to achieve a refined and healthy nose.

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

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