Nasal structure and correction methods for a bulbous, widened nose

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce a surgical case of a patient who was troubled by nasal bridge pain, headaches, and an unstable, shifting implant.

This patient had undergone surgery with an I-shaped silicone implant 20 years ago and had recently been taking long-term medication for severe rhinitis.

- Pain in the glabella and nasal bridge (particularly severe when wearing glasses)

- Mobility of the silicone implant

- Intermittent pain along the nasal dorsum

- Severe rhinitis

Front view:

- The nasal bridge appears swollen and widened, with a drooping tip

- The nasal tip is blunt and bulbous

- The alae are splayed and drooping

- The philtrum appears long

Oblique view:

- The nasal tip appears bulbous and drooping

- Findings of a protruding mouth are observed

Profile view:

- The nasal tip looks compressed and bulbous

- Retracted columella and the appearance of a protruding mouth are observed

- Receding chin is observed

Nostrils:

- Slight nostril asymmetry is visible

- The nostrils appear compressed and splayed

1. Removal of existing silicone implant

2. Partial removal of tissue around the implant

3. Placement of a new implant (thinner and wider than the previous one)

4. Tip elevation and nasolabial angle correction

5. Septoplasty and septal extension

1. Removal of the existing implant:

- Removal of a rigid silicone implant measuring 8 mm in width and 3 to 4 mm in thickness

- Removal of granulation tissue around the implant and irrigation with saline

2. Nasal tip reconstruction:

- Removal of scar tissue around the lower lateral cartilages

- Septal extension performed using autologous rib cartilage

- Reshaping and elevating the nasal tip

3. Nasolabial angle correction:

- Lowering the columella and correcting the nasolabial angle

- Expected improvement in protruding mouth appearance

4. Placement of the new implant:

- Placement of an implant designed with minimal height and thickness

- Positioned beneath the periosteum to ensure stability

5. Septoplasty:

- Corrected only the deviated portion minimally to preserve cartilage

Front view:

- The previously widened nasal bridge is slimmer, with swelling reduced

- The bulbous nasal tip has been naturally elevated

- Alar spreading has improved

Oblique view:

- Drooping of the nasal tip is corrected, achieving a natural height

- The appearance of a protruding mouth has been softened

Profile view:

- The nasal tip is naturally lifted, and bulbousness is improved

- Columellar retraction is corrected, creating a natural nasolabial angle

- Visible improvement in protruding mouth appearance

Nostrils:

- Nostril asymmetry has improved

- The previously compressed nostril shape looks natural

This was a complex case requiring aesthetic improvement alongside the resolution of complications from an old rhinoplasty (pain, implant mobility).

By combining multiple techniques—including removal of the old implant and replacement with a new one, nasal tip reconstruction using autologous rib cartilage, and nasolabial angle correction—both functional and aesthetic improvements were achieved.

In this particular case, neuralgia due to a chronic foreign body reaction was suspected, so the focus was placed on eliminating the foreign body reaction and relieving pressure.

Symptom changes will be closely monitored through follow-up visits over a 6-month period after surgery, and additional measures will be taken if necessary.

Following rhinoplasty, some patients occasionally experience a feeling of pressure or pain along the nasal bridge. Most of these cases arise within 6 months after surgery and naturally improve over time as scar tissue diminishes. In some patients, the thickness of the implant exceeds what the nasal bridge can comfortably accommodate, making adaptation difficult. In such cases, lowering the implant height can resolve the issue.

When dorsal pain develops several years or decades later after being asymptomatic initially, a chronic foreign body reaction to the implant or acute or chronic inflammation should be considered. In most of these cases, the issue can be resolved simply by surgically evaluating the condition of the dorsum, correcting the implant position, and performing thorough irrigation.

If you are considering rhinoplasty or experiencing discomfort following a past surgery, I recommend consulting an ENT specialist to identify the precise cause and determine the appropriate solution.

I always prioritize patient safety and satisfaction, striving to achieve the intended results.

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

Thank you.

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