Why an overly high nose looks unnatural and deviates, and how it can be reconstructed

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce the case of a patient who improved a Pinocchio-like overprojected nose, nasal deviation, and breathing discomfort caused by previous surgeries through autologous rib cartilage and septal reconstruction.

10 years ago

• Ear cartilage + silicone implant

• Outcome: Bulbous nose, no significant change

2 years ago

• Autologous rib cartilage + silicone implant

• Outcome: Overly high, Pinocchio-like nose, deviation, breathing discomfort

Patient information

• Symptoms of nasal obstruction present

• Various issues stemming from previous surgeries

Primary concerns

• Pinocchio-like, unnaturally high nose

• Asymmetric deviation to the left and right

• Persistently bulbous nasal tip

• Breathing discomfort

• Long-appearing midface

Structural concerns

• Severe septal damage

• Excessive height

• Unnatural nasal line

• Accompanied by functional problems

• Correction of bulbous nose

• To make the midface appear shorter

• Correction of crooked nose

Autologous rib cartilage reconstruction

• Removal of existing silicone implant

• Full reconstruction with autologous rib cartilage

• Adjustment to a natural height

Septal reconstruction

• Complete reconstruction of the damaged septum

• Use of autologous rib cartilage

• Improvement of breathing function

Correction of crooked nose

• Midline alignment

• Balancing left and right symmetry

• Straight nasal line

Nasal sill reduction

• Reduction of the widened nasal sill

• Refined nostril shape

• Improving overall balance

Adjustment of glabella radix

• Lowering the radix at the glabella

• Natural transition zone

• Soft radix takeoff

Correction of the nasolabial angle

• Improvement in protruding mouth appearance

• Visual midface shortening effect

• Achieving an ideal angle

Front view

• Straight nose

• Refined nasal tip

• Balanced nostrils

Complete correction of crooked nose

• Accurate midline alignment

• Restoration of bilateral symmetry

• Straight nose

Profile view

• Natural nasal height

• Improved nasolabial angle

• Ideal projection

• Harmonious profile line

Improvement of bulbous nasal tip

• Sleek, refined nasal tip

• Improvement in both frontal and profile views

• Natural tip shape

Midface shortening effect

• Shortened appearance by lowering the radix

• Additional improvement via nasolabial angle correction

• Improving overall facial proportions

Natural nasal height

• Correction of the Pinocchio-like nose

• Height in harmony with the face

• Natural nasal line

Improvement of breathing function

• Relief of nasal obstruction

• Comfortable breathing

This was the case of a patient who was unsatisfied despite undergoing two prior rhinoplasties. In particular, after the surgery 2 years ago, the patient suffered from an excessively high nose described as "Pinocchio-like," nasal deviation, and breathing discomfort.

The greatest concerns were the excessive height and unnatural shape. In the previous surgery, simply pursuing height without considering facial proportions resulted in an unnatural, Pinocchio-like nose. To resolve this, the existing silicone implant was removed, and autologous rib cartilage was used to reconstruct a natural height and profile.

The septal damage was severe. Because the septum had been severely damaged by prior surgeries, complete reconstruction using autologous rib cartilage was necessary. This was an essential step not only for aesthetic improvement but also for restoring breathing function.

The midface shortening effect requested by the patient was achieved by combining several techniques. Lowering the radix made the nose visually appear shorter, and correcting the nasolabial angle provided an additional shortening effect. Concurrently, the appearance of a protruding mouth improved, enhancing overall facial balance.

Nasal sill reduction was an important component of this surgery. By reducing the nasal sill that had widened from previous procedures, a more refined and balanced nose was achieved. This significantly improved the aesthetic appearance on the front view.

Correction of the deviated nose was also successful. Along with septal reconstruction, the external structural framework was accurately aligned to create a straight, balanced nose. This contributed to functional breathing improvement as well as cosmetic enhancement.

The bulbous tip problem, which remained unresolved after the initial surgery 10 years ago, was also fully addressed. Autologous rib cartilage was used to reconstruct the tip framework, achieving a sleek and refined nasal tip.

As a result, all the improvements requested by the patient were successfully achieved. The unnatural, Pinocchio-like nose became natural, the deviation was corrected, and the midface appeared shorter. Most importantly, nasal breathing improved, allowing the patient to carry on daily life comfortably.

This case serves as a prime example of achieving a successful outcome by accurately analyzing the problems from prior surgeries and pursuing appropriate proportions and natural harmony tailored to the patient's face.

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

Postoperative precautions and potential complications