Why a bulbous, drooping nose makes the midface look long, and reconstruction methods using calcified rib cartilage

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce the case of a patient who visited our clinic concerned about a bulbous, drooping nose and the perceived length of the midface.

• 17 years ago: Rhinoplasty

• 7-8 years ago: Filler injection (nasal bridge, columella) - not dissolved

• History of rhinitis

• "I want to improve the wide, flared appearance"

• "I do not want a pinched look"

• "I want to refine my bulbous tip naturally"

• "I want my midface to look shorter"

• "I want to lift the drooping nose naturally"

During this surgery, there was the challenge of harvesting severely calcified autologous rib cartilage, but by reconstructing it carefully with safety in mind, we were able to achieve a natural result.

1. Harvesting autologous rib cartilage and foreign material removal

• Careful harvest of severely calcified rib cartilage

• Removal of the existing implant from the surgery 17 years ago

• Complete removal of filler injected 7-8 years ago

• Preparation for tissue reconstruction planned with safety in mind

2. Nasal tip reconstruction and length adjustment

• Septal extension using autologous rib cartilage

• Refining the bulbous nasal tip naturally

• Adjusting the long, drooping nose to appear shorter

• Forming support structures to gather a wide nasal tip

3. Nasolabial angle correction and philtrum-shortening effect

• Improving the nasolabial angle by lifting the drooping nose

• Creating the visual effect of a shorter philtrum

• Improving the perceived length of the midface

• Achieving a natural profile line

4. Adjusting the radix starting point

• Lowering the radix starting point to establish harmonious proportions

• Correcting the midface so it does not appear elongated

• Overall facial balance

• A natural transitional contour

5. Septal reconstruction and functional improvement

• Improving breathing function through septal reconstruction

• A structural approach to relieve rhinitis symptoms

• Turbinoplasty and septoplasty

• Securing long-term stability

6. Achieving a natural nasal contour

• A natural shape without a pinched look

• Balanced improvement of a wide nose

• Harmony with the overall face

• An elegant profile silhouette

Front view changes:

• Natural refinement of the bulbous nasal tip

• A wide, spread nose was gathered with balanced proportions

• A natural shape without a pinched look

• Improving overall facial proportions

• A refined, elegant frontal line

Profile view changes:

• Adjustment of the long, drooping nose to look shorter

• Philtrum looks shorter through nasolabial angle correction

• Natural improvement in perceived midface length

• Harmonious proportions by adjusting the radix starting point

• An elegant and refined profile line

Nostril view changes:

• Improvement of bulbous nasal tip

• Natural nostril shape

• Achieving bilateral balance

• Alignment of the columellar midline

• Improvement in overall symmetry

This case involved handling calcified rib cartilage, which is one of the difficult situations frequently encountered in revision rhinoplasty. Severely calcified rib cartilage makes harvesting itself quite technically challenging and requires a meticulous approach. However, by harvesting it carefully, we were able to deliver the natural result the patient wanted.

In this particular case, the patient was troubled not only by a bulbous, drooping nose, but also by the appearance of an elongated midface. Rather than simply changing the nose alone, an integrated approach considering the balance and proportions of the entire face was necessary.

By lifting the drooping nose through nasolabial angle correction, we created the visual effect of a shorter philtrum, and by appropriately adjusting the radix starting point, we prevented the midface from appearing too long. These precise adjustments came together to complete harmonious overall facial proportions.

Additionally, after removing the implant from 17 years ago and the filler from 7-8 years ago, we reconstructed the nose using autologous rib cartilage while also addressing rhinitis through a functional approach. Revision rhinoplasty requires more precise and meticulous planning than primary surgery, and an even more prudent approach is essential when dealing with calcified tissue.

While fulfilling both of the patient's requests to "improve the wide appearance" and "avoid a pinched nose," we also improved the perceived midface length, making the overall facial balance much more harmonious.

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.

#calcifiedribcartilage #autologousribcartilage #revisionrhinoplasty #bulbousnose #droopingnose #midfacecorrection #nasolabialanglecorrection #philtrumshortening #radixadjustment #widenoseimprovement #naturalnose #foreignbodyremoval #fillerremoval #rhinitisimprovement #closedrhinoplasty #closedrevisionrhinoplasty