Why nasal tip cartilage shows through the skin and turns upward: reinforcement and reconstruction methods

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

Today, I would like to introduce a complex revision rhinoplasty case of a patient who was concerned about an upturned nose and cartilage showing through so thinly that it seemed ready to break through the nasal tip skin.

• 15 years ago in Bucheon: surgery with an I-shaped silicone implant and ear cartilage (septal cartilage use unclear)

Primary concerns

• Nasal tip cartilage visible through extremely thinned skin, as if about to protrude

• Pointed and severely upturned nasal tip

Front view

• Upturned nasal shape

• Excessive nostril show

• Nostril asymmetry

• High radix

Profile view

• Pointed nasal tip

• Retracted columella with poor visibility

• Wide nasolabial angle

Nostrils

• Nostril asymmetry

• Columella tilted to the left

• Resolving the visibility of the nasal tip cartilage

• Correction of an upturned nose

• Correction of nostril asymmetry

• Achieving a natural nasal line

Structural improvement

• Septal extension using autologous cartilage

• Nasal tip cartilage repositioning and skin reinforcement using donor dermis

• Removal of existing silicone implant

• Correction of the nasolabial angle

• Lower lateral cartilage repositioning to improve nostril symmetry

• Deviated septum and rhinitis surgery to improve nasal function

Improvement in shape

• Correction of upturned nose

• Improving the pointed nasal tip

• Adjustment of columellar position and angle

• Lowered glabella radix

Skin reinforcement surgery

• Peritip fat grafting for thinned nasal tip skin with cartilage show-through

• Improving nasal tip skin thickness and texture using donor dermis

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

Front view

• Improvement in upturned nasal shape

• Significant reduction in nasal tip cartilage visibility

• Reduction of nostril show

• Enhanced nostril symmetry

• More natural glabella

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

Profile view

• Natural nasal tip shape

• Correction of the upturned nasal tip

• Adequate columellar show

• Harmonious nasolabial angle

• Balanced nasal line

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

Nostrils

• Symmetric nostril shape

• Straightened columella

• Stable nostril architecture

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

The patient had undergone surgery 15 years prior using an I-shaped silicone implant and ear cartilage. The main concerns were cartilage showing through the nasal tip so thinly that it looked as though it might break through the skin, along with a severely upturned nasal tip. In addition, nostril asymmetry and a columella tilted toward the left required correction.

The highest priority was placed on reinforcing the nasal tip skin. Visibility of the cartilage beneath the nasal tip occurs when the overlying skin has thinned excessively, and this was addressed through skin reinforcement using fat grafting and donor dermis. By restoring appropriate thickness and elasticity to the thin skin, we significantly reduced the cartilage visibility and achieved a natural tip shape.

The upturned nose was corrected using autologous cartilage for septal extension and cartilage repositioning at the nasal tip. By adjusting the orientation and angle of the tip cartilages, the upturned tip was lowered to a natural position, and the sharp tip contour was softened. During this process, the position and angle of the columella were also adjusted to straighten the columella, which had been tilted to the left.

The previous silicone implant was removed, and autologous rib cartilage was used to reposition the tip cartilages and secure a stable support structure, while the nasolabial angle was adjusted to create a harmonious profile line. In addition, nostril asymmetry was addressed by meticulously repositioning the cartilages and correcting the deviated columella, achieving a balanced appearance on the frontal view as well.

This was a meaningful case where we focused on the primary issues of thinned tip skin and an upturned nose while comprehensively addressing various secondary problems, including nostril asymmetry and columellar deviation. In particular, the use of fat grafting and donor dermis to reinforce the nasal tip skin served as the key technique that effectively resolved the patient's unique concerns.

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

Thank you.

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