How to correct an upturned nose and overly curved bridge after repeated surgeries

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the story of a patient who finally achieved the desired result after their 6th revision rhinoplasty.

Between 2009 and 2014, the patient underwent a total of 5 rhinoplasties. Various materials and surgical techniques were attempted, including septal cartilage, ear cartilage, donor rib cartilage, autologous rib cartilage, and silicone implants, but each result remained unsatisfactory and brought continued distress. In addition, the patient received nasal filler injections 8 years ago.

A thorough analysis of the patient's nose during the preoperative consultation revealed the following concerns:

1. Upturned nasal tip

2. High nasal bridge starting point

3. Overly curved bridge line with an unnatural, operated appearance

4. Nostril asymmetry and alar scarring caused by aggressive philtrum reduction and alar reduction

5. Poor columellar scarring resulting from repeated open rhinoplasties

1. Desired outcome: a nose that looks refined yet natural

2. Straight bridge line

3. Correction of upturned nose

4. Correction of nostril asymmetry

1. Septal extension to correct the upturned nose and delicately refine the tip shape

2. Reuse of previously grafted autologous tissues (autologous rib cartilage, septal cartilage, and ear cartilage)

3. Harvesting additional autologous rib cartilage to use as the primary material for the tip

4. Removal of foreign materials (filler and the existing silicone implant)

5. Carving and placing a new silicone implant with a lower radix than the previous position

As anticipated, the surgery was not straightforward. Due to multiple prior procedures, normal anatomical tissues had sustained severe damage, and extensive scar tissue was present. In particular, the septal cartilage was severely compromised, which had destabilized the nasal tip support and ultimately led to the upturned tip; therefore, septal reconstruction was performed using autologous rib cartilage.

Evaluating the result immediately after surgery, the upturned tip was lowered naturally, and the radix was lowered to approximately the pupil line. This softened an otherwise harsh facial impression. The apparent deviation was also substantially improved. The nasolabial angle was corrected to approximately 95 degrees, improving the appearance of a protruding mouth, and the excessive dorsal curvature was nearly eliminated, achieving a straight bridge line with a gentle upward tip.

This case reaffirms that rhinoplasty, and revision rhinoplasty in particular, requires an extremely meticulous and specialized approach. An optimal surgical plan must be established by comprehensively evaluating the patient's surgical history, the condition of the remaining tissues, and the patient's goals. Furthermore, to achieve a natural result, the patient's overall facial proportions and individual characteristics must be taken into account. Rather than simply following current trends, finding the nasal shape that harmonizes best with each individual is essential.

For those considering rhinoplasty, I strongly encourage careful consideration and thorough consultations. Especially in revision cases, I recommend consulting with an experienced specialist to determine the most appropriate approach for your situation.

I will continue to prioritize patient safety and satisfaction, striving to deliver the intended results.

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

Thank you.

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