An uneven nasal bridge after a dermal graft: causes and implant-free reconstruction

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce the case of a patient whose wide nasal tip, nostril asymmetry, and uneven nasal bridge were naturally improved using implant-free autologous rib cartilage.

January 2020

• Full rhinoplasty (no implant, ear cartilage at the nasal tip)

March 2022

• Dermal graft to the nasal bridge

Patient information

• Female in her 30s

• No history of double jaw surgery, facial contouring, or filler

Primary concerns

• Wide, bulbous nasal tip

• Nostril asymmetry

• Uneven surface of the nasal bridge

• Low, sunken glabella

• Drooping nose (long nose)

• Mildly protruding mouth

Patient's specific requests

• Wished for added height, but without an operated look

• Strong preference for an implant-free approach

• Prioritized a natural result

Problems from the previous surgery

• Uneven surface caused by the dermal graft

• Persistently low glabella

• Unresolved bulbous nose

• Correction of the drooping nose and bulbous tip

• Correction of nostril asymmetry

• Elevated yet natural nose

• Safety through an implant-free approach

Implant-free reconstruction with autologous rib cartilage

• Reconstruction of both the nasal bridge and nasal tip using autologous rib cartilage

• Complete removal of the existing dermis

• Smoothing of the uneven surface

Elevation of the glabella

• Reinforcement of glabellar volume using autologous rib cartilage

• Natural filling of the sunken glabella

• Creation of a smooth transition

Nasal tip reconstruction

• Refining the wide nasal tip

• Defining the bulbous nasal tip

• Securing sufficient structural support

Correction of nostril asymmetry

• Securing symmetry by improving the size and shape of both nostrils

• Natural nostril shape

• Improving frontal aesthetics

Correction of the nasolabial angle

• Correction of the drooping nose

• Visual shortening effect through tip elevation

• Improvement of the mildly protruding mouth

Surface refinement

• Smoothing the uneven nasal bridge

• Natural nasal line

• Creating a gentle curve

Front view

• Elevated glabella

• Smooth nasal bridge

• Symmetric nostrils

• Sleek nasal tip

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 height

• Gentle nasal contour

• Improved nasolabial angle

• Harmonious profile line

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

Achieving a natural height

• Natural height without an operated look

• Harmonious proportions with the face

• Smooth line from the glabella to the nasal tip

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

Correction of the drooping nose

• Shortened appearance through nasolabial angle correction

• Youthful, vibrant impression

• Improvement of overall facial proportions

Surface improvement

• Smooth and natural nasal bridge

• Improved unevenness

• Smooth skin surface

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

Restored nostril symmetry

• Balanced nostrils on both sides

• Natural shape

• Improved frontal aesthetic

Complete correction of the bulbous nose

• Noticeably refined wide nasal tip

• Sleek, refined nasal tip

• Improvement in both frontal and profile views

This case involved a patient who struggled with an uneven nasal bridge caused by dermis used in a prior surgery, alongside an unresolved bulbous nose and nostril asymmetry. In particular, the patient strongly desired a higher nose while maintaining a natural appearance without looking operated.

The most significant issue, the uneven nasal bridge, stemmed from the inherent limitations of dermal grafts. Over time, dermis can undergo irregular absorption or deformation, resulting in an uneven surface. To resolve this, the dermis was completely removed and replaced with autologous rib cartilage.

Choosing an implant-free approach was a sensible decision. Because autologous rib cartilage is the patient's own tissue, there is no risk of foreign-body reaction or infection, and natural texture and mobility can be preserved. It was a suitable option especially for a patient who desired a natural result without an operated look.

The low and sunken glabella was addressed by adding appropriate volume with autologous rib cartilage. Rather than creating an overly abrupt change, the height was adjusted naturally to harmonize with the face. This precisely fulfilled the patient's request for a nose that is elevated yet natural.

The bulbous nose with a wide, blunt tip was improved by reconstructing the supporting structure with autologous rib cartilage. While refining and defining the nasal tip, an understated, natural shape was maintained.

Nostril asymmetry required delicate correction. By improving the size and shape of both nostrils, symmetry on the frontal view was restored. This was an essential element in refining the overall balance of the nose.

The drooping nose was improved by adjusting the nasolabial angle. Elevating the nasal tip appropriately created the visual impression of a shorter nose, which also helped soften the appearance of the mildly protruding mouth.

Overall, the patient's key priority, naturalness, was placed above all else. While achieving sufficient improvement, we were able to create a natural nose that looked innate, avoiding any artificial look.

Consequently, the uneven nasal bridge became smooth, the low glabella was naturally elevated, the wide tip was refined, and the nostril asymmetry was corrected. Most importantly, we were able to achieve the elevated yet natural nose that the patient had envisioned.

This case serves as a good example demonstrating that implant-free surgery with autologous rib cartilage can produce sound and effective outcomes.

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

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