Correction methods addressing a small nose and nostril asymmetry together

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a closed rhinoplasty case of a 28-year-old female patient.

Through this case, let us examine the precautions and methods for achieving natural results when operating on a small nose.

Age: 28-year-old female

Surgical history: None

Special notes: Allergy to painkillers

Requests: A longer and higher nose

1. A blunt nasal tip with an overall wide, spread appearance

2. Retracted columella

3. The columella is hidden behind the alae and not visible from the profile view

4. Protruding mouth findings

5. Irregular nasal bridge

6. Nostril asymmetry

1. Septal extension using septal cartilage and donor rib cartilage

2. Projecting the nasal tip and naturally lowering the columella

3. Gathering the spread nasal tip through cartilage interdome suturing

4. Repositioning and suturing the lower lateral cartilages to correct the bulbous tip

5. Improvement of protruding mouth through nasolabial angle correction

6. Smoothing and refining the nasal dorsum

7. Placing a silicone implant after dorsal hump reduction

8. Improving nostril asymmetry through septal extension and lower lateral cartilage suturing

Important note: In cases with a small nose, the skin does not stretch easily, so raising the nasal tip excessively can pose risks. In this case, the tip was elevated only up to about 90% of the skin's stretching limit, and the skin was reinforced with a dermal graft to prevent show-through of the tip cartilage.

• Naturally elevated nose (patient request)

• Short nasal tip appropriately lengthened (patient request)

• Improved tip shape

• Corrected nostril asymmetry

• Improvement in protruding mouth appearance

Through this case, we could review several key points to consider during rhinoplasty. In particular, this patient had an allergy to specific painkillers. Before surgery, information regarding the patient's current medications and drug allergies is critical. This is because it may lead to issues related to anesthesia during surgery or postoperative complications such as bleeding. Because cosmetic surgery must prioritize safety above all else, this aspect is even more important. Since the patient was allergic to a specific painkiller formulation, an alternative painkiller was prescribed, and injections were administered during surgery to prevent unforeseen allergic reactions, allowing the surgery to conclude safely.

Furthermore, when operating on a small nose, raising the nasal tip excessively can cause issues such as a pinched tip, cartilage show-through, or tip redness, requiring caution. It is always important to consider the patient's tip skin dimensions and thickness to achieve a safe and natural result.

I will always strive to support your aesthetic goals and health. If you have any questions, please feel free to leave a comment at any time.

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

Thank you.

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