Revision rhinoplasty methods for a short and upturned nose

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a revision rhinoplasty case of a patient who was concerned about a short nose and an upturned nose.

The patient had undergone multiple surgeries previously, but had not achieved a satisfactory result.

For the past 2 years, the nose had become increasingly upturned, causing significant concern. The patient was also experiencing discomfort from nasal obstruction.

Through this case involving multiple complex issues, I will discuss the importance and effectiveness of customized rhinoplasty.

The surgical history in this case is as follows:

1. 10 years ago: Silicone implant + ear cartilage graft

2. 5 years ago: Silicone implant + ear cartilage + septal cartilage graft

3. 6 months later: Additional AlloDerm graft to correct cartilage show-through

a) Correction of short and upturned nose

b) Improvement of nasal obstruction

Let us analyze the patient's condition in detail:

Front view:

- Significant nostril show

- Overall small and thin appearance

Profile view:

- Upturned while simultaneously appearing drooped

- The radix is high

- Bulbous appearance

Oblique view:

- Overall short appearance

Nostrils:

- Slight nostril asymmetry observed

- The columella is slightly tilted to the right

Considering the patient's condition and requests, the following surgical plan was established:

a) Reuse of previously placed cartilage:

- Reuse the previously harvested septal cartilage and ear cartilage to the extent possible

b) Donor rib cartilage grafting:

- Perform septal extension using donor rib cartilage as the primary material

c) Nasal bridge implant exchange:

- Removal of pre-existing implant

- Lower the radix and place a new silicone implant

d) Additional procedures to improve nasal obstruction:

- Septoplasty

- Submucosal resection of the inferior turbinate using radiofrequency

This plan was established based on preoperative nasal obstruction examinations. The findings revealed septal deviation to the left and bilateral hypertrophy of the inferior turbinates, leading to a diagnosis of deviated septum and hypertrophic rhinitis.

Using a closed approach, the surgery was performed as follows:

a) Donor rib cartilage grafting:

- Performed septal extension using donor rib cartilage combined with the previously placed septal cartilage.

b) Reuse of previously placed cartilage:

- The previously grafted septal and ear cartilages were carefully harvested without damage; the septal cartilage was used alongside donor rib cartilage for septal extension, while the ear cartilage was reused to elevate the nasal tip, minimizing unnecessary tissue loss.

c) Nasal bridge implant exchange:

- Removed the existing implant.

- Lowered the radix starting point and placed a new silicone implant to create a natural nasal bridge line.

d) Septoplasty:

- Corrected the septum deviated to the left.

e) Submucosal resection of the inferior turbinate:

- Hypertrophic inferior turbinate tissue was reduced using radiofrequency.

- Widened the nasal airway to improve breathing function.

f) Nasolabial angle adjustment:

- Appropriately adjusted the nasolabial angle, reducing the appearance of a protruding mouth.

g) Nostril and columellar correction:

- Improved nostril asymmetry and straightened the deviated columella.

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

Front view:

- Excessive nostril show was naturally reduced and improved.

- The overall small and thin appearance gained better definition and balance.

Profile view:

- The upturned and drooped appearance was naturally corrected.

- The high radix was lowered, improving overall nasal length proportion.

- The blunt tip area became more refined and natural.

- Adjustment of the nasolabial angle reduced the appearance of a protruding mouth.

Oblique view:

- The shortened length was restored, improving facial proportions.

- The profile line from bridge to tip became smoother and more natural.

Nostrils:

- Mild nostril asymmetry was improved.

- The columella, which had deviated to the right, was straightened.

This case serves as a representative example of customized rhinoplasty performed in a complex scenario involving multiple prior surgeries.

Multiple concerns were resolved simultaneously while achieving a natural, harmonious result.

Key points to note include:

1. Combining autologous cartilage with donor rib cartilage to offset limitations:

To mitigate potential resorption of donor rib cartilage, the previously placed septal cartilage was reused in conjunction with donor rib cartilage for septal extension.

2. Recycling previously used cartilage:

Minimizing unnecessary tissue loss improved surgical efficiency.

3. Achieving both aesthetic and functional improvement simultaneously:

While refining the external shape, breathing function was enhanced through septoplasty and turbinate reduction.

4. Closed approach: Successfully performed complex surgery without external scars.

Through this surgery, the patient's primary concerns were addressed, and nasal obstruction improved. Furthermore, the overall facial harmony and balance became more refined.

7. Conclusion

I hope this case offers helpful insight for patients concerned about a short, upturned nose, as well as those hesitant about autologous rib cartilage harvesting. Revision rhinoplasty requires a meticulous approach tailored to each individual's anatomy and goals.

Drawing on extensive experience and clinical expertise, I provide surgical plans optimized for each patient. As a board-certified otolaryngologist, I pursue rhinoplasty that improves breathing function alongside aesthetic refinement through detailed anatomical understanding.

If you are considering rhinoplasty, I recommend consulting with a specialist to determine the most suitable surgical approach for your needs.

I will always do my best to support both the health and aesthetic harmony of your nose, so you can smile with confidence.

This was Dr. Peter C. Kang. Thank you.

Thank you.

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