Bulbous nasal tip unresolved by previous surgeries: causes and reconstruction methods

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce the case of a patient who underwent revision rhinoplasty because their bulbous nose did not improve after previous surgeries.

7 years ago

• Silicone implant + septal cartilage

4 years ago

• Ear cartilage + silicone implant removal (changed to implant-free)

2 years ago

• Philtrum reduction

4 years ago

• 2 filler treatments (dissolved only 1 time)

Patient information

• Medical conditions: Anemia

• Allergies: Hyaluronidase

• No functional discomfort

Aesthetic concerns

• Bulbous nasal tip (not improved by previous surgeries)

• Excessive nostril show

• Retracted columella with poor visibility

• Overall long-appearing nasal line

• Deformity of the right alar cartilage

• Protruding mouth findings

Special notes

• Subtle deformity caused by residual filler

• Structural complexity due to multiple prior surgeries

• Correction of bulbous nose

• Reduced nostril show

• Correction of the nasolabial angle

• Desire for columellar show

• Preference for a shorter, refined, and projected look

• Natural yet refined outcome

Complete removal of foreign material

• Complete removal of residual filler

• Debridement of scar tissue from previous surgeries

Septal reconstruction

• Septal reconstruction using autologous rib cartilage

• Stabilizing the central nasal axis

• Optimized respiratory function

Alar reconstruction

• Right alar cartilage reconstruction

• Improvement of left-right symmetry

• Restoration of natural alar contour

Structural reconstruction

• Full reconstruction using autologous rib cartilage

• Transforming the bulbous tip into a defined, refined tip

• Creating a natural columellar appearance

• Achieving the desired shorter nasal length

Improvement in shape

• Minimizing nostril show

• Improvement of protruding mouth through nasolabial angle correction

• Adjusting the overall length of the nasal line

• A contour harmonious with the patient's face

Functional improvement

• Optimizing respiratory function via septoplasty

• Improving the internal airway environment via inferior turbinate surgery

Individualized considerations

• Considering the patient's nasal tip skin characteristics

• Preventing an overly sharp tip from excessive projection

• Achieving the desired design while maintaining a natural appearance

Functional improvement

• Optimized respiratory function through septal reconstruction

• Stabilization of internal structures

• Securing long-term respiratory function

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

Front view

• Improvement of the bulbous tip

• Improved bilateral balance through right alar reconstruction

• Appropriate nostril show

• Balanced overall 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-appearing columella

• Improved nasolabial angle

• Softened appearance of a protruding mouth

• Shorter, refined nasal line

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

Overall changes

• Complete resolution of previously persistent bulbous shape

• Realization of the projected tip contour desired by the patient

• Natural yet refined overall impression

• Favorable outcome tailored to individual facial characteristics

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

Long-term stability

• Long-term stability using autologous rib cartilage

• Stabilization of the central axis through septal reconstruction

• Elimination of risks associated with reusing filler or foreign materials

• Lasting and natural results

This case involved a patient who wished to fundamentally resolve a bulbous nasal tip that previous surgeries had failed to correct. In particular, while the patient preferred a natural line during our consultation 1 year ago, they now desired a more refined, shorter nasal appearance, requiring a completely different surgical plan.

The patient's greatest concern was that despite multiple surgeries, the bulbous appearance had not changed. Although the silicone implant had been removed in a prior surgery to transition to an implant-free nose, ear cartilage alone appeared insufficient to create a refined shape for the nasal tip.

The patient brought reference photos of their desired design, in which the models had notably thick tip skin. Compared with this patient's skin characteristics, pursuing the same level of height could result in an unnatural, overly sharp tip, a point I explained in detail during the consultation.

The most crucial step was completely removing the residual filler. Because only 1 of the filler treatments received 4 years ago had been dissolved, the remaining filler was having a subtle effect on the shape. After completely removing this, we proceeded with full reconstruction using autologous rib cartilage.

Additionally, the right alar cartilage required reconstruction. Because previous surgeries had compromised the shape and symmetry of the right ala, precise reconstruction was performed to balance both sides.

Septal reconstruction was another vital component. Reconstructing the septum with autologous rib cartilage stabilized the central axis of the nose and supported long-term respiratory function.

Achieving the shorter look the patient desired while minimizing nostril show and improving columellar visibility was technically demanding. By utilizing the robust structural support of autologous rib cartilage, the tip was appropriately elevated while maintaining a balanced, natural outcome.

Correcting the nasolabial angle improved the appearance of the protruding mouth and enhanced overall facial harmony. Since the patient had double eyelid surgery scheduled for the following week, designing a nose that considered their overall facial balance was particularly critical.

As a result, the bulbous nasal tip that remained unresolved through previous surgeries was thoroughly corrected. The patient achieved the shorter, refined nasal contour they desired while preserving harmony with their natural facial features, and they are very satisfied.

This was a meaningful case where a completely new surgical plan was established to meet the patient's changed goals, achieving a tailored outcome that carefully accounted for their unique individual characteristics.

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

Thank you.

#closedrhinoplasty #revisionrhinoplasty #autologousribcartilage #bulbousnosecorrection #fillerremoval #shortnose #septalreconstruction #alarreconstruction #customrhinoplasty