Revision rhinoplasty methods for correcting both a long nose and asymmetry

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce a revision rhinoplasty case that resolved a long nose and asymmetry issues resulting from multiple prior nasal surgeries.

🔍 Surgical history

2015: Silicone implant + nasal bone reduction + donor rib cartilage
2019: Alar reduction
May 2023: Silicone implant + nasal bone reduction + donor rib cartilage
October 2023: Revision rhinoplasty due to deviation
March 2024: Implant-free septal reconstruction (SR) + alar base elevation + foreign material removal
18 perioperative stem cell therapy sessions

Design consultation: front, left oblique, and profile views

📊 Preoperative analysis

Right profile, oblique, and nostril views during design consultation

Front view
- Broad nasal bridge
- Alar and nostril asymmetry
- Nasal tip deviated to the right
Profile view
- High radix starting point
- Elongated nose
- Sharp nasal tip
- Retracted columella
Nostrils
- Columella deviated to the right
- Nostril asymmetry

🔧 Surgical plan and details

Structural reconstruction
- Septal extension using autologous rib cartilage (to improve nasal tip deviation)
- Correction of deviated septum
- Right alar reconstruction and cartilage graft
Asymmetry correction
- Nostril lowering via right nostril skin graft
- Correction of alar asymmetry through right alar elevation
Management of preexisting foreign material
- Removal of autologous rib cartilage particles from the nasal bridge and alae
Glabellar refinement
- Bone rasping in the glabellar area
- Lowering the radix by adjusting skin thickness
Final contouring
- Placement of a thinly carved silicone implant (improving bridge widening and irregularities)

Revision rhinoplasty methods for correcting both a long nose and asymmetry — Before surgery / day 0 immediately after surgery. Photos taken immediately after surgery include swelling and may differ from the final result.

Before surgery / Day 0 immediately after surgery Photos taken immediately after surgery show swelling and may differ from the final result.

🌟 Surgical results

Front, profile, and oblique views immediately after surgery on day 0 Photos taken immediately after surgery show swelling and may differ from the final result.

Revision rhinoplasty methods for correcting both a long nose and asymmetry — Day 0 nostril view immediately after surgery. Photos taken immediately after surgery include swelling and may differ from the final result.

Nostril view on day 0 immediately after surgery Photos taken immediately after surgery show swelling and may differ from the final result.

💡 Key improvements

Correction of nostril asymmetry
Correction of deviated nasal tip
Natural-looking refinement of a widened nasal bridge
Reduction of nostril show
Natural columellar line
Lowering the glabellar radix starting point

Particularly noteworthy is the correction of the glabellar radix starting point. Because of the patient's existing bridge height, lowering the starting point was technically demanding; however, by suitably rasping the glabellar bone and partially debulking subcutaneous tissue, a natural profile line was achieved.

💡 Closing remarks

Many patients face distress over a nose that has become elongated and markedly asymmetrical following repeated rhinoplasties. In such cases, rather than a routine revision rhinoplasty, a tailored approach that considers the overall balance of the face is necessary.

I hope this case offers reassurance to those experiencing similar concerns. Rhinoplasty requires meticulous planning that takes into account both individual facial characteristics and prior surgical history. NOSELAB will always remain committed to helping patients resolve their nasal concerns.

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

Thank you.

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These before-and-after photos apply only to the specific patient shown; expected results can only be determined in consultation with a doctor. The following complications may occur after any surgery. Infection: Prevented with disinfection and antibiotic injections or oral medication, but revision surgery may rarely be required. (Less than 0.5%) Bleeding: Nasal packing is placed for 1–2 days to minimize bleeding. (Occasional bleeding may occur after rhinitis surgery.) Allergic reaction Asymmetry: During consultation, we explain that improvement may not be complete, depending on facial asymmetry and the condition of the nose. Insufficient cosmetic or functional improvement Other complications, such as excessive scarring or skin necrosis, may also occur.

Revision rhinoplasty methods for correcting both a long nose and asymmetry — Photo 20

Limitations and risks

When autologous rib cartilage is used, scarring and pain may remain at the donor site on the chest, and pneumothorax (pleural injury) can occur rarely. Over time, the grafted cartilage may warp or undergo partial resorption.

When using donor rib cartilage, long-term follow-up is necessary because the grafted cartilage may resorb or warp.

When revising after implant removal, contracture may progress again after removal, the nasal height and length may decrease, and staged surgery may be necessary depending on the skin condition.

When foreign materials such as injected fillers are removed and reconstructed, contracture may recur, nasal height and length may decrease, and staged surgery may be necessary depending on the skin condition.

When the septum is corrected at the same time, nasal obstruction may persist or recur, and in rare cases, septal perforation or changes in smell may occur.

Common potential risks include infection, bleeding, asymmetry, scarring, skin necrosis, and insufficient improvement; results vary depending on individual skin condition and previous surgical history.

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