Why a thick columella and upturned nasal tip develop, and how autologous rib cartilage reconstruction is performed

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce a revision rhinoplasty case of a patient who visited us to correct a thick columella and an upturned nose.

In particular, this case involved a complex history of multiple prior surgeries, inflammation, and repeated use of autologous rib cartilage, requiring a meticulous approach.

1. Front view

• Bulbous and wide nose

• Pinched appearance on both sides

• Excessive nostril show

• Nostril asymmetry

2. Profile view

• Upturned nose

• Obtuse nasolabial angle

• Uneven nasal bridge

• Unnatural nasal line

3. Nostrils

• Severe asymmetry

• Thick columella

• Smaller nostrils

• Unnatural nostril shape

During surgery, the following severe conditions were identified:

• Severe septal cartilage damage with almost no normal structure remaining

• Lower lateral cartilages almost completely lost

• Substantial amount of scar tissue and foreign material present on the nasal dorsum

• Partial resorption of previous autologous rib cartilage

In particular, chest X-rays revealed extensive calcification in the bilateral rib cartilage. Considering that autologous rib cartilage had already been harvested twice from the right side, the left rib cartilage with the least calcification was carefully selected and safely harvested.

1. Structural reconstruction

• Complete reconstruction of the damaged septum using autologous rib cartilage

• Reconstruction and reinforcement of the lower lateral cartilages

• Application of cartilage repositioning and cartilage suturing

• Reduction of columellar width

2. Foreign material and scar management

• Complete removal of existing contracted tissue

• Removal of remaining foreign material

• Improvement of stretched skin

• Normalization of columellar thickness

3. Functional improvement

• Correction of deviated septum

• Concurrent rhinitis surgery

• Additional treatment to improve nasal obstruction

1. Front view improvement

• Natural correction of the previously flared appearance

• Correction of excessive nostril show

• Correction of nostril asymmetry

• Resolution of bilateral pinched appearance

• Improved overall balance

2. Profile view improvement

• Natural correction of the upturned nasal tip

• Normalization of the nasolabial angle

• Smooth nasal bridge line

• Creation of a harmonious profile

3. Nostril improvement

• Normalization of columellar width

• Improved left-right asymmetry

• Correction of nostril size

• Achievement of a natural contour

This case presented numerous constraints, including a history of multiple revision rhinoplasties, inflammation, repeated autologous rib cartilage harvest, and philtrum reduction surgery. However, through precise problem analysis and a systematic approach, a successful outcome was achieved.

In particular, the following principles were strictly observed:

1. Maximum reconstruction of normal anatomical structures

2. Safe removal of foreign materials

3. Step-by-step contracture correction

4. Balance between function and aesthetics

Drawing on extensive surgical experience, this was a meaningful case demonstrating that the intended result can be attained even in complex revision rhinoplasty scenarios. NOSELAB will continue to do our best for our patients' health and natural beauty.

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

Thank you.

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