Why the nose looks deviated to one side and feels blocked at night: septal reconstruction and nasal obstruction relief

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who underwent autologous rib cartilage reconstruction alongside surgery for nasal obstruction to address a crooked nose, a long nose, and severe facial asymmetry.

10 years ago

• Nasal filler injection → dissolved

8 to 9 years ago

• Ear cartilage and dorsal hump reduction in Apgujeong

Patient information

• Symptoms: nasal obstruction during sleep, snoring

• Notable finding: severe facial asymmetry

Primary concerns

• Nose appearing deviated to the left

• Imbalance in facial proportions due to a long nose

• Bulbous nose (flared nasal tip)

• Lack of definition due to insufficient height

Functional issues

• Nasal obstruction during sleep

• Snoring symptoms

• Suspected deviated septum

Special notes

• Nasal deviation worsened by severe facial asymmetry

• Structural issues unresolved by prior surgery

• Need for simultaneous aesthetic and functional improvement

• Complete correction of crooked nose

• Achieving a tall, well-defined nose

• Improving the long-appearing nose

• Refining the nasal tip through bulbous tip correction

Autologous rib cartilage reconstruction

• Removal and replacement of previous surgical materials

• Using rib cartilage to secure sufficient height

• Reinforcing structural stability

Septal reconstruction

• Fundamental correction of the crooked nose

• Correction of deviated septum

• Precise correction taking facial asymmetry into account

Correction of the nasolabial angle

• Adjusting the nasolabial angle to improve the long nose

• Midface-shortening effect by elevating the nasal tip

• Creating a refined, shorter-appearing nose

Surgery for nasal obstruction

• Septoplasty: improving nasal obstruction

• Turbinoplasty: securing space within the nasal cavity

• Improving snoring and breathing during sleep

Correction of facial asymmetry

• Maximum possible compensation considering severe facial asymmetry

• Precise surgery to balance left and right

• Improvement in visual symmetry

Front view

• Straight nose without deviation

• Compensatory effect for facial asymmetry

• Refined and prominent nasal line

• 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

• Tall, well-defined profile

• Effect of a shorter-appearing nose

• Ideal nasolabial angle

• Graceful nasal curve

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

Achieving a tall, well-defined nose

• Prominent profile achieved with adequate height

• Refined, sophisticated nasal line

• Achieved the distinct nose the patient desired

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

Improving the long-appearing nose

• Shortened appearance through nasolabial angle correction

• Improvement in overall facial proportions

• Achieving a youthful and refined appearance

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

Bulbous nose correction

• Focused refinement of the broad nasal tip

• Sleek, refined nasal tip

• Clean line from both the front and profile views

Functional improvement

• Relief of nasal obstruction symptoms

• Significant reduction in snoring

• Comfortable breathing during sleep

Complete correction of crooked nose

• Straightening the left-deviated nose

• Compensatory effect for facial asymmetry

• Restoration of a natural midline

This patient presented with persistent concerns regarding a crooked nose, a long nose, and a bulbous tip, despite having received nasal filler 10 years ago and an ear cartilage graft with dorsal hump reduction 8 to 9 years ago. In particular, the nasal deviation appeared more pronounced due to severe facial asymmetry.

The patient's primary concern was the nose appearing deviated to the left. This was not merely an external aesthetic issue, but the combined result of a deviated septum and underlying facial asymmetry. To resolve this, structural correction through septal reconstruction was essential.

Reconstruction using autologous rib cartilage was chosen to achieve the tall, prominent nose the patient desired. Because ear cartilage from the previous surgery could not provide sufficient height and structural stability, rib cartilage was utilized to ensure definite improvement.

Adjusting the nasolabial angle was key to correcting the elongated appearance of the nose. By elevating the nasal tip appropriately and refining the nasolabial angle, we created a visual shortening effect. This also contributed significantly to balancing the overall facial proportions.

Correction of the bulbous tip involved reorganizing the tip structure to bring the broad nasal tip together. By reinforcing the tip support structure with autologous rib cartilage, we were able to create a slim and refined nasal tip.

Functional concerns could not be overlooked. Because the patient suffered from nasal obstruction and snoring during sleep, septoplasty and inferior turbinoplasty were performed concurrently to secure space in the nasal cavity and improve respiratory function.

The most challenging aspect in this type of case was performing the correction while taking severe facial asymmetry into account. While complete symmetry is not possible, maximizing visual balance helped achieve a more harmonious face. This approach considered overall facial harmony rather than focusing solely on the nose itself.

As a result, all of the patient's goals were accomplished. The crooked nose was straightened, a tall and well-defined line was created, and the elongated appearance was resolved. The bulbous tip was also refined, completing an overall sophisticated and well-balanced nose.

Most importantly, achieving comfortable breathing and better sleep through functional improvement was a significant achievement. This was a successful case that improved both aesthetics and function simultaneously.

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

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