Rhinoplasty method considering the nasal bridge starting point and facial proportions

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce a rhinoplasty case of a male patient who had significantly prominent brow bones, a low glabella, and a wide, spread-out nose.

In particular, to correct the appearance where the nose looked even lower due to a low radix, I will show a case where raising the starting point naturally connected the forehead-to-glabella line.

This patient had received nasal filler 10 years ago and desired a natural straight bridge line that harmonized well with his face.

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

Front view:

- Low glabella (low nose)

- Overall low and wide, spread-out nose

- Nostril and alar asymmetry observed

- The philtrum appears long

Oblique view:

- Excessively prominent brow bones

- Low glabella (low nose)

- Presentation of a protruding mouth

Profile view:

- Low glabella and prominent brow bones

- Nose appears short and small relative to the face

- The nasal tip appears drooping

- Protruding mouth and receding chin observed

Nostrils:

- Nostril asymmetry is present

- Alar asymmetry observed

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

a) Insertion of a glabellar silicone implant

b) Septal extension using autologous rib cartilage

c) Septoplasty

d) Submucosal resection of the inferior turbinate using radiofrequency

e) Lower lateral cartilage repositioning and suture suspension

f) Existing filler removal and silicone implant insertion

The following procedures were performed using a closed approach:

a) Insertion of a glabellar implant:

- To soften the appearance of prominent brow bones, a silicone implant was carved to fit the brow bone contours and inserted into the glabella, naturally connecting the line by raising the starting point.

b) Septal extension graft:

- Correcting nasal tip spreading, asymmetry, and drooping using autologous rib cartilage

c) Septoplasty and submucosal resection of the inferior turbinates:

- Treating deviated septum and hypertrophic rhinitis to improve nasal obstruction

d) Lower lateral cartilage repositioning and suture suspension:

- Correcting the spreading and bulbous appearance of the nasal tip

e) Nasal bridge implant insertion:

- Surgical removal of existing filler

- Inserting a silicone implant to smooth out uneven contours

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 nose, which previously appeared short and wide, achieved natural proportions

- The wide, spread-out appearance was corrected

- Improved nostril asymmetry

- Excessive nostril show was improved

Profile view:

- The prominent brow bones and previously depressed glabella were naturally connected

- The uneven nasal bridge was smoothed into a straight bridge line

Oblique view:

- The appearance of the protruding mouth improved significantly

- The bulbous nasal tip achieved a more natural shape

Nostrils:

- Nostril asymmetry improved substantially

- Discrepancy between the alae was reduced

This case addressed multiple combined concerns simultaneously, including prominent brow bones, a low nose, and a wide, spread-out shape. Notably, to address the combination of prominent brow bones and a low glabella (low nose), a properly carved implant was placed in the glabella to raise the starting point.

Septal extension using autologous rib cartilage effectively improved multiple nasal tip concerns (spreading, asymmetry, drooping), while concurrent septoplasty and inferior turbinate surgery provided functional improvement.

Removing the existing filler to smooth the uneven contours of the nasal bridge and inserting a silicone implant also delivered a favorable result.

In male patients with excessively prominent brow bones and a low nose, the appropriate use of nasal bridge implants is very important. Sometimes, highly customized implants made with 3D printing are considered. In this case, however, the transition angle descending from the brow bone to the glabella was favorable, so a 3D-printed implant was not deemed necessary.

I hope this case is helpful to those concerned about a low nose, a wide nose, or prominent brow bones. Rhinoplasty is not merely about the nose alone; it must take overall facial harmony into account. In particular, it is important to consider the relationship between the glabella and brow bones, nasal height and length, and the bridge line comprehensively to create a natural, harmonious result.

I always establish a tailored surgical plan by carefully considering each patient's facial characteristics and requests. If you are considering rhinoplasty, I encourage you to consult with a specialist to find the most suitable method for you.

I will be with you every step of the way to achieve a beautiful and healthy nose.

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

Thank you.

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