Why nostril asymmetry and a drooping tip develop: reconstruction combining different cartilages

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

Today, I would like to introduce a revision rhinoplasty case of a patient who was troubled by nostril asymmetry and a drooping tip.

• 10 years ago: Hiko thread lift procedure

• 7 years ago: Pearl rhinoplasty (silicone implant in the nasal tip)

• 6 years ago: Silicone implant removal surgery

• 1 year ago: Nasal filler injection (never dissolved)

Characteristics

• Congenital nostril asymmetry

• Drooping nasal tip

• Traces from the silicone implant that had shifted to the right

• Residual filler

• Correction of nostril asymmetry (the most concerning issue)

• Improvement of drooping tip

• Natural shape without sharp points

• Improvement without significantly changing the patient's current appearance

• Reluctance to use autologous rib cartilage

Structural improvement

• Septal extension using both donor rib cartilage and autologous cartilage (septal cartilage)

• Combination with autologous cartilage to minimize shape changes caused by donor rib cartilage resorption

• Complete removal of existing filler

• Removal of residual foreign material from previous procedures

• Correction of the nasolabial angle

Improvement in shape

• Correction of nostril asymmetry (within the limitations of congenital alar asymmetry)

• Elevation of the drooping tip

• Creating a natural nasal profile line

• Considering overall harmony

Front view

• Naturally improved nostril asymmetry

• Balanced nasal shape

• Maintaining an appropriate balance of nose size

• Overall natural impression

Profile view

• Improved tip position

• Adequate nasal height

• Natural nasolabial angle

• Natural nasal tip that is not pointed

Nostrils

• Nostril symmetry improved as much as possible within congenital limitations

• Balanced nostril shape

• Stable tip support structure

This was a complex case involving nostril asymmetry, a drooping tip, and a history of multiple procedures and surgeries. The nostril asymmetry, which was the patient's greatest concern, stemmed from congenital alar asymmetry. Although there were limitations to complete correction, the focus was placed on achieving the most natural improvement possible.

Considering that the nose was not large, the drooping tip was effectively corrected without excessively elevating the tip.

Although the patient was reluctant to use autologous rib cartilage, donor rib cartilage was combined with the patient's own septal cartilage to build a sturdy support structure for a stable result. In particular, autologous cartilage was used together with donor rib cartilage to minimize potential shape deformities caused by resorption that can occur when using donor rib cartilage alone. Residual filler and traces from the previous silicone implant were completely removed, and the nasolabial angle was corrected to achieve a natural profile line.

In accordance with the patient's wish to avoid a drastic change in image, the areas of concern were effectively improved, resulting in a natural and harmonious outcome. This was a meaningful case where optimal balance and harmony of the nasal contours were achieved within the limitations of congenital nostril asymmetry.

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

Thank you.

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