Why the columella droops and nostrils become visible: correcting a crooked nose and nostril asymmetry

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who visited our clinic concerned about a drooping columella, a crooked nose, and nostril asymmetry.

• Around 10 years ago: Nose filler + Misko procedure (to be removed during surgery)

• 9 to 10 years ago: Silicone implant + Alloderm

• 8 to 9 years ago: Revision surgery (adjustment) - Silicone repositioning (to correct a crooked nose)

• "I want to raise my nose higher."

• "I want to reduce the size of my nostrils."

• "I want to correct my crooked nose."

• "I want to lift my drooping columella naturally."

• "I want to reduce excessive nostril show."

• "I want to correct my nostril asymmetry."

In this surgery, the core objectives were to remove the silicone implant placed during the previous surgery, elevate the drooping columella, and naturally refine the exposed nostrils.

1. Existing implant removal and reconstruction

• Removal of silicone and Alloderm from the previous surgery

• Removal of filler and Misko from 10 years ago

• Reconstruction with safety in mind using autologous rib cartilage

2. Columellar correction

• Elevating the drooping columella into a natural position

• Adjusting the nasolabial angle to establish a refined profile line

• Reducing nostril show seen from the profile view

3. Crooked nose correction

• Realigning the crooked nasal bridge through lateral osteotomies

• Aligning the nasal midline with septal reconstruction

• Securing front-view symmetry

4. Alar rim graft (nostril lowering)

• Partial incision of the lower lateral (alar) cartilage

• Lowering the alar margin by grafting autologous rib cartilage

• Naturally reducing the excessively exposed nostril area

• Balancing the size of both nostrils

5. Increasing nasal height

• Dorsal augmentation using autologous rib cartilage

• Achieving the natural height desired by the patient

• Considering harmony with overall facial proportions

6. Nasolabial angle correction

• Minimizing nostril show visible from the profile view

• Natural angle with the philtrum

• Achieving an elegant profile silhouette

Frontal changes:

• Securing symmetry through crooked nose correction

• Improving left-right balance

• Formation of a natural bridge line

• Achieving the patient's desired nasal height

• Improvement in overall facial balance

Profile changes:

• Naturally elevated drooping columella

• Improvement of excessive nostril show

• A refined profile line

• Forming a harmonious angle with the philtrum

• An elegant profile with an improved nasolabial angle

Nostril changes:

• Reduced nostril show by correcting the drooping columella

• Decreased nostril size

• Achieving bilateral symmetry

• Alignment of the columellar midline

• Natural nostril shape

Correcting a drooping columella is not simply about lifting the columella; it is a delicate procedure that requires simultaneous consideration of the nasolabial angle and nostril show. Particularly in cases with a history of two prior surgeries like this, safely removing existing implants and reconstructing damaged tissues were essential.

After removing the previous silicone implant and Alloderm, a stable framework was rebuilt using autologous rib cartilage. Because the patient had a history of revision surgery for a deviated nose 8 to 9 years ago, the focus this time was placed on addressing the crooked nose fundamentally through septal reconstruction.

Through alar rim grafting, where the lower lateral cartilage is partially incised and augmented with autologous rib cartilage, the excessive nostril show visible from the profile view was naturally corrected. At the same time, elevating the drooping columella properly adjusted the nasolabial angle, giving the profile line a far more refined and elegant appearance.

In addition, to meet the patient's desire for increased nasal height, the dorsum was naturally augmented using autologous rib cartilage. By utilizing autologous tissue rather than the artificial implants used in previous surgeries, a more stable and natural long-term result can be expected.

Revision rhinoplasty requires a more precise and meticulous approach than primary surgery because it involves navigating scar tissue and altered structures from prior operations. For this case, each issue was resolved systematically by thoroughly analyzing the patient's surgical history and current tissue condition.

I will continue to provide customized surgeries that reflect each patient's individuality and requests through this meticulous approach. I hope this helps those with similar concerns.

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

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