Why the columella retracts and the nasal tip becomes bulbous years after rhinoplasty, and how to reconstruct it

Hello, this is Dr. Peter C. Kang, medical director.

Today, I would like to share the case of a patient whose retracted columella and bulbous nasal tip were corrected using autologous rib cartilage.

• 14 years ago: Dorsal hump rasping, tip cartilage suturing

• 12 years ago: Osteotomies, septal cartilage harvest, alar reduction

Front view

• Deviated nasal bridge

• Bulbous nasal tip

• Retracted columella

• Nostril asymmetry

• Alar asymmetry

Profile view

• Drooping tip

• Protruding mouth findings

• Retracted columella

Nostrils

• Nostril asymmetry resulting from previous alar reduction surgery

• Previous surgical scar on the columella

• Restoration of the retracted columella

• Improvement of bulbous nasal tip

• Natural result

Structural reconstruction

• Septal extension using autologous rib cartilage

• Autologous cartilage graft to restore the retracted columella

• Autologous rib cartilage grafting and repositioning to correct the bulbous nasal tip

• Lateral osteotomy for crooked nose correction

Improvement in shape

• Restoration of retracted columella

• Correction of the bulbous nasal tip and a natural profile line

• Improvement of the crooked nose through correction of nasal bone asymmetry

• Correction of the nasolabial angle

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

Front view

• Straightened nasal bridge

• Natural nasal shape

• Improved nostril symmetry

• Balanced alae

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

Profile view

• Naturally lowered columella

• Well-defined nasal tip and a natural nasal bridge line

• Improved tip position

• Correction of the nasolabial angle

• 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.

Nostrils

• Improvement of nostril asymmetry

• Softened appearance of the previous surgical scar

This was a complex case where severe columellar retraction and a bulbous nasal tip developed after a dorsal hump rhinoplasty 14 years ago and revision rhinoplasty 12 years ago. Cartilage in the columellar area had weakened from the prior procedures, leading to retraction, while the nasal tip became bulbous, disrupting overall facial balance.

This surgery focused on two main goals. The first was columellar reconstruction using autologous rib cartilage. By using sturdy autologous rib cartilage to reconstruct the retracted columella, structural stability of the nose was secured. The second was refining the bulbous nasal tip. Cartilage grafting, cartilage suturing, and repositioning techniques were used to create a natural, well-balanced tip contour that is not overly sharp.

At the same time, septal extension was performed to strengthen support for the nasal tip, and lateral osteotomies corrected the deviated nasal bridge. In particular, columellar reconstruction and tip refinement naturally improved both the front and profile silhouettes, while adjusting the nasolabial angle softened the appearance of the protruding mouth. The patient's nostril asymmetry from previous alar reduction was also meticulously addressed to achieve overall harmony.

As the patient desired, the result was not overly artificial; the columellar retraction was fully corrected, and the nasal tip was naturally refined. Structural reconstruction using autologous rib cartilage provides not only cosmetic improvement but also a solid foundation that helps maintain stable results over the long term.

This has been Dr. Peter C. Kang, medical director.

Thank you.

#closedrhinoplasty #columellareconstruction #tiprefinement #bulboustipcorrection #autologousribcartilage #customrhinoplasty