Surgical approach for an upturned and crooked nose

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the transformation story of a patient who decided to undergo revision rhinoplasty due to concerns about an upturned and crooked nose.

Through this case, let us examine in detail how complex nasal issues can be resolved and how a patient's specific requests can be reflected to achieve a satisfying result.

This patient had already undergone two prior rhinoplasty procedures.

- 2022: Ear cartilage to the nasal tip, autologous rib cartilage to the nasal bridge

- February 2024: Nasal tip with autologous rib cartilage, nasal bridge with silicone implant, deviated septum correction, foreign material removal

- April 2024: Alar lift

However, the results remained unsatisfactory, leading the patient to visit our clinic.

1. Lower the radix

2. Raise the nasal tip by 2 mm

3. Remove foreign material from the nasal bridge

4. Correct the nasolabial angle so the philtrum does not look elongated

5. Lengthen and lower the nasal tip, improving the frontal ACR (alar-columellar relationship)

6. Reconstruct the nasal bridge without implants, leaving a slight dorsal hump

7. Create a rounded columella on the profile view

8. Lengthen the nostril appearance on the profile view

9. Correct the crooked appearance from the front

10. Correct the protruding cartilage on the left side of the columella

Let us analyze the patient's condition in detail:

Front view:

Front view

- The nasal tip appears wide and spread out

- The radix appears high

- The nasal bridge appears crooked

- Nostril asymmetry is observed

- The nose appears wide and spread out overall

Profile view:

- The nasal tip is drooping

- The radix is high

- Signs of a protruding mouth are visible

Nostrils:

Basal view

- The nasal tip tilts to the right

- Nostril asymmetry is present

- Cartilage appeared protruding on the left side of the columella

The following procedures were performed using a closed approach:

a) Autologous rib cartilage harvest and grafting:

- A sufficient amount of autologous rib cartilage was harvested and used to reconstruct the nasal tip and nasal bridge.

b) Nasal tip reconstruction:

- Using autologous rib cartilage, septal extension was performed to project the nasal tip by 2 mm and add length.

- A natural nasal tip was created while considering the ACR (alar-columellar relationship).

c) Nasal bridge reconstruction:

- After removing the existing silicone implant and foreign material, the nasal bridge was reconstructed using autologous rib cartilage.

- In accordance with the patient's request, a subtle dorsal hump contour was created.

d) Septoplasty and inferior turbinate reduction:

- Septoplasty was performed to improve nasal obstruction.

- Submucosal resection of the inferior turbinate using radiofrequency was performed to improve rhinitis symptoms.

e) Lateral osteotomy:

- Lateral osteotomy was performed to correct the wide, crooked nasal structure.

f) Correction of the nasolabial angle:

- The nasolabial angle was appropriately adjusted to improve the appearance of a protruding mouth and philtrum length.

g) Nostril lowering:

- Nostril lowering surgery was performed to improve the shape of the nostrils.

h) Alar reinforcement:

- The alae were reinforced using autologous cartilage.

i) Radix correction:

- The high-appearing radix was lowered to improve the overall length proportion of the nose.

j) Removal of protruding cartilage in the columella

- A protruding cartilage fragment on the left side of the columella was excised during surgery.

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 previously splayed nasal tip was gathered for a more refined appearance.

- The radix, which appeared high, was lowered naturally.

- The nasal bridge, which appeared crooked, was straightened.

- Nostril asymmetry improved significantly.

- The nose, which previously appeared wide overall, became slimmer.

- The ACR was improved.

Profile view:

- The drooping tip was adequately elevated and lengthened, creating a refined look.

- Lowering the radix improved the overall perceived length of the nose.

- The protruding mouth has improved, enhancing overall facial balance.

- The columella was contoured smoothly, giving a softer impression.

- A subtle dorsal hump was incorporated into the bridge to achieve a distinctive profile.

Oblique view:

- The overall nasal profile line became more natural.

- The projection and length of the nasal tip were improved harmoniously.

Nostrils:

- The nasal tip, which tilted to the right, was centered.

- Nostril asymmetry was improved.

- The cartilage that protruded from the left columella was removed, resulting in a clean contour.

- The superior margin of the nostril on profile view, which previously appeared rounded and blocked, was straightened out smoothly (per the patient's request).

Immediately after surgery (Day 0) nostrilsImmediate postoperative photos show swelling and may differ from the final result.

This procedure was a customized surgery designed with thorough consideration of the patient's requests. Because enhancing individual satisfaction is a primary objective in aesthetic surgery, NOSELAB always strives to accommodate each patient's needs to the fullest extent possible.

In this case as well, the patient's detailed requests were carefully identified and incorporated into the surgical plan, and checking each requested point after surgery helped achieve a high level of satisfaction.

I hope this case offers encouragement to those troubled by complex nasal concerns such as an upturned, crooked, or drooping nose. Revision rhinoplasty requires an even more meticulous approach, but a satisfying result can be achieved through appropriate surgical planning and precise technique.

We always prioritize our patients' needs. Based on extensive experience and advanced surgical techniques, I will do my utmost to help you achieve the nasal shape you desire.

If you are considering rhinoplasty, especially revision surgery, I encourage you to consult with a specialist to find the most suitable method for you. NOSELAB is here to support you toward a beautiful and healthy nose.

Thank you.

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