Why an autologous dermal graft absorbs, leading to a widened bridge and upturned nose, and how to correct it

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce the case of a patient who visited our clinic concerned about an upturned appearance of the nose. We were also able to address the widened and crooked nasal bridge caused by significant absorption of the buttock dermis used in a previous surgery.

• 25 years ago: Silicone implant (no noticeable improvement)

• 19 years ago: L-shaped silicone implant (due to an upturned nose)

• 15 years ago: L-shaped silicone implant + ear cartilage (due to an upturned nose)

• 10 years ago: Buttock dermis + ear cartilage + septum + silicone implant removal (due to an upturned nose, which the patient suspected was contracture)

• 2 years ago: 2 sessions of nasal filler (never dissolved)

• "I want to correct my upturned nose naturally"

• "I want to make my nasal bridge smooth"

• "I want to improve my crooked nose"

• "I am concerned about my widened nasal bridge"

• "I want to correct my depressed dorsum"

The key goals of this surgery were correcting the upturned nose while refining the bridge—which had widened and deviated due to buttock dermis absorption—into a natural, straight bridge line.

1. Foreign material removal and tissue evaluation

• Complete removal of the nasal filler injected 2 years ago

• Assessment of the existing buttock dermis

• Debridement and reshaping of the significantly absorbed dermis tissue

• Evaluation of the septum and ear cartilage status

2. Creating a natural nasal bridge line with revision rhinoplasty

• Using a stable material in place of the absorbed buttock dermis

• Reducing the widened bridge width

• Correction of the deviated nasal bridge

• Creation of a natural straight bridge line

3. Upturned nose correction via septal extension

• Naturally lowering the tip position

• Creating an appropriate nasolabial angle

• An elegant profile line

• Securing stable support for the nasal tip

4. Correction of the depressed dorsum

• Addressing the overall upturned look

• Forming the bridge line into a natural, straight bridge line

• A smooth nasal bridge surface

• Improvement in overall balance

5. Lowering the nostril rims

• Naturally correcting the upturned nostrils

• Improving bilateral nostril symmetry

• Alignment of the columellar midline

• Natural nostril shape

Front view changes:

• The upturned appearance was naturally corrected

• Reduction in the widened nasal bridge width

• Restored symmetry by correcting the crooked portion

• Enhancing overall facial balance

• Smooth nasal bridge line

Profile view changes:

• The upturned nasal tip was lowered naturally

• Straight bridge line achieved by correcting the depressed dorsum

• An elegant profile achieved by correcting the nasolabial angle

• A refined and natural profile silhouette

• Harmonious overall proportions

Nostril view changes:

• Upturned nostrils naturally corrected

• Natural positioning achieved by lowering the nostril rims

• Achieving bilateral balance

• Alignment of the columellar midline

• Natural nostril shape

Correcting an upturned nose is not simply about pulling the nasal tip down. It is a complex procedure that requires comprehensive consideration of the overall nasal balance, nasolabial angle, and facial harmony.

In this case, the patient had a history of four surgeries over 25 years. In particular, significant absorption of the buttock dermis graft used 10 years ago caused the bridge to widen and appear crooked. Because autologous buttock dermis tends to absorb over time, it is a material that requires caution regarding long-term structural stability.

During surgery, intraoperative findings confirmed that the buttock dermis had absorbed more than expected. This absorption caused the bridge to widen and the nose to look upturned overall. In addition, the dorsum was depressed, which made the upturned appearance even more noticeable.

In this revision, we focused on refining the absorbed dermis and using stable material to create a natural, straight bridge line. We reduced the widened bridge width and corrected the crooked deviation to secure symmetry.

To correct the upturned nose, we performed septal extension. By lowering the nasal tip naturally while maintaining an appropriate, well-balanced nasolabial angle, we established an elegant profile line. Furthermore, lowering the alar rims naturally corrected the visible, upturned nostrils.

Correcting the depressed dorsum and refining the bridge into a straight line played a major role in eliminating the overall upturned look. The harmonious combination of a smooth bridge surface and a natural, straight line helped create a refined and elegant impression.

Revision rhinoplasty for a patient with multiple previous surgeries requires an extremely meticulous approach. With accurate diagnosis, systematic planning, and refined surgical techniques, we were able to achieve the natural result the patient wanted.

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.

#upturnednosecorrection #nasalbridgeline #alarrimlowering #buttockdermisabsorption #widenedbridge #crookednose #revisionrhinoplasty #multiplerevisionrhinoplasty #straightbridgeline #septalextension #fillerremoval #foreignbodyremoval #naturalnose #closedrhinoplasty #closedrevisionrhinoplasty