Why a low nasal bridge and bulbous tip persist after multiple surgeries: rib cartilage reconstruction and facial balance

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who underwent autologous rib cartilage rhinoplasty, paranasal augmentation, and chin implant surgery simultaneously to improve a low nasal bridge, protruding mouth, and overall facial balance.

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

• Visited the clinic via Twitter

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

Main concerns

• Low nasal bridge

• Lack of height between the eyebrows

• Bulbous nose (flared nasal tip)

• Nasolabial folds associated with a protruding mouth

• Overall facial disharmony

Aesthetic preferences

• A refined and natural-looking nose

• Adequate height between the eyebrows

• Sleek nasal tip

• Overall facial harmony

What to avoid

• Drooping nose

• An overly dramatic nose

• Elevating the low nose

• Definite correction of the bulbous tip

• Appropriate elevation of the nasal bridge

• Improvement of nasolabial folds

• Balancing the entire face

Autologous rib cartilage reconstruction

• Removal of previous dermal graft and replacement with rib cartilage

• Securing sufficient height

• Reinforcing structural stability

Projecting the nasal tip

• Reinforcing the tip support structure with autologous rib cartilage

• Creating a slim and refined nasal tip

• Complete correction of the bulbous nose

Correction of the nasolabial angle

• Improvement in protruding mouth appearance

• Softening nasolabial folds

• Ideal nasolabial angle

Paranasal augmentation

• Restoring midface volume

• Additional improvement of nasolabial folds

• Three-dimensional facial contour

Chin implant surgery

• Improving the protruding mouth by advancing the chin

• Overall facial balance and harmony

• Improvement of the aesthetic line (E-line)

Comprehensive approach

• Integrated surgery considering both the nose and the entire face

• Calculating optimal proportions for each area

• Pursuing natural harmony

Effects of nasal correction

• Transition from a low nose to an appropriately elevated nose

• Resolution of the bulbous tip for a slim nasal tip

• Natural yet refined nasal line

• Securing height between the eyebrows

Improvement of nasolabial folds

• Increased midface volume via paranasal augmentation

• Additional improvement through nasolabial angle correction

• Youthful, vibrant impression

Front view

• Elevated height between the eyebrows

• Sleek nasal tip

• Improved nasolabial folds

• Balanced facial proportions

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

• Improved protruding mouth

• Ideal E-line

• Harmonious facial profile

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

Improvement of protruding mouth

• Visual retrusion of the lips via nasolabial angle correction

• Chin advancement with a chin implant

• Creation of an ideal E-line

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

Overall facial balance

• Harmonious proportions between the nose, midface, and chin

• Three-dimensional and balanced face

• Overall refined impression

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

This patient had undergone two rhinoplasties, in 2020 and 2022, but was still troubled by an uncorrected low nasal bridge and bulbous tip. In particular, because the patient also wanted to improve a protruding mouth and overall facial balance, a comprehensive approach was necessary.

The patient's greatest concern was the low nose. In previous surgeries, only ear cartilage without implants had been used, followed later by a dermal graft, which failed to achieve sufficient height. By using autologous rib cartilage, we were able to secure both clear height improvement and structural stability.

Correcting the bulbous tip was another crucial goal. Because the patient desired a definite correction, the tip support structure was completely reconstructed with autologous rib cartilage to create a slim, refined nasal tip. At the same time, naturalness was preserved to prevent an overly dramatic appearance that the patient wished to avoid.

Addressing the protruding mouth required a multifaceted approach. By correcting the nasolabial angle, the angle between the nose and upper lip was refined, and the chin was advanced with a chin implant to improve the overall facial profile. Through this, an ideal E-line could be established.

The nasolabial folds were not merely a sign of aging, but the combined result of a protruding mouth and insufficient midface volume. Paranasal augmentation added volume to the midface, and together with the effect of nasolabial angle correction, the nasolabial folds improved noticeably.

The key feature of this surgery was the comprehensive approach. Rather than focusing solely on elevating the nose, rhinoplasty, paranasal augmentation, and chin implant surgery were performed concurrently, taking the balance of the entire face into account. Each procedure created synergy, yielding a harmonious overall result.

As a result, all of the patient's desired improvements were achieved. The low nasal bridge was corrected to an appropriate height, and the bulbous tip was fully addressed. With the improvement in the protruding mouth and nasolabial folds, a more youthful and refined impression was created, and above all, a satisfying outcome was achieved through overall facial balance and harmony.

This case was meaningful in demonstrating that facial balance concerns that cannot be resolved through rhinoplasty alone can be successfully improved with a comprehensive approach.

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

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