Why a nose becomes short and upturned with a retracted columella, and how autologous rib cartilage reconstruction works

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a case of autologous rib cartilage reconstruction for a patient who had long struggled with an upturned nose.

• 18 years ago: Surgery with Alloderm + silicone implant + ear cartilage (suspected Alloderm inflammation, leading to an upturned nose)

• 17 years ago: Surgery with septal cartilage + ear cartilage + silicone implant (upturned nose persisted even after 6 months)

• 6 months later: Silicone implant removal

• 3 months later: Revision surgery with silicone implant + cartilage

1. Front view

• Upturned-looking nose

• Nostril asymmetry

• Deviated nose

2. Profile view

• Short and upturned nose

• High radix starting point

• Retracted columella

• Philtrum appears long

• Protruding mouth findings

3. Oblique view

• Short and upturned nose

• Elongated-looking philtrum

• Protruding mouth findings

4. Nostril view

• Nostril asymmetry

• Columella deviated to the left

• Scar tissue on the upper left columella

• Allergy to cephalosporin antibiotics

• Worsened rhinitis after rhinoplasty

• Appears like a contracted nose

• Correction of the upturned nose (reduced nostril show)

• Natural result

1. Evaluation of findings

• Confirmation that more than 2/3 of both lower lateral cartilages were removed in previous surgeries

• Confirmed columellar retraction and an acute nasolabial angle

• Scar tissue on the left columella

2. Structural reconstruction

• Lower lateral cartilage reconstruction using autologous rib cartilage

• Correction of the upturned nose via septal extension

• Lowering the columella

3. Shape improvement

• Improvement of protruding mouth through nasolabial angle correction

• Naturally lowering the radix at the glabella

• Correction of nostril asymmetry

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

1. Front view

• Reduction of nostril show

• Improvement of asymmetry

• Straightened nasal line

• Correction of an upturned nose

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

2. Profile view

• Natural radix position

• More natural columella shape

• Improved nasolabial angle

• Philtrum appears less elongated

• Improvement of protruding mouth

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

3. Nostrils

• Balanced nostril asymmetry

• Straightened columella

• Scar tissue appears reduced

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

This was a case where the patient had undergone several rhinoplasty surgeries over a long period of 18 years, yet struggled with an upturned nose and retracted columella that never improved. Upon examination during surgery, it was confirmed that more than 2/3 of both lower lateral cartilages had been removed, which weakened the supporting structure and caused the upturned nose.

Although the patient mistook this for a contracted nose, it was actually a deformity resulting from damage to normal cartilage structures. Using autologous rib cartilage, the lower lateral cartilages were reconstructed and septal extension was performed to correct the upturned nose. In addition, the columella was lowered naturally, improving the nasolabial angle and addressing the appearance of a protruding mouth.

Because the patient had an allergy to cephalosporin antibiotics, special care was taken in medication selection, and surgery was conducted while also taking into account the patient's pre-existing aggravated rhinitis symptoms.

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

Thank you.

#closedrhinoplasty #revisionrhinoplasty #upturnednosecorrection #autologousribcartilage #customrhinoplasty