Why a crooked dorsal hump and drooping tip occur, and how septal extension is performed

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce the case of a patient who visited our clinic with concerns regarding a crooked dorsal hump and a drooping tip.

This was the patient's first rhinoplasty.

The patient visited our clinic with the following concerns:

1. Crooked dorsal hump: Nasal bone deviation and a hump causing asymmetry on the front view

2. Drooping tip: A downward-drooping tip giving a tired and aged impression

3. Protruding mouth: The appearance of mouth protrusion on the profile view

4. Rhinitis: Chronic nasal obstruction and breathing discomfort

5. Natural improvement: A natural nose that matches the patient's facial features without being overdone

In this patient's case, a natural result was desired while correcting the crooked dorsal hump and drooping tip. Additionally, nasal obstruction caused by rhinitis needed to be addressed at the same time.

1. Nasal bone lateral osteotomy

• Precise correction of deviated nasal bones

• Natural removal of the dorsal hump

• Achieving bilateral symmetry

• Formation of a balanced nasal bridge line on the front view

2. Septal extension (donor rib cartilage + septal cartilage)

• Elevating the drooping tip to create a more open impression

• Stable structural support by using donor rib cartilage together with septal cartilage

• Appropriate adjustment of the tip angle

• Shaping a natural yet refined tip

• Maintaining long-term tip stability

3. Utilization of septal cartilage and ear cartilage

• Building the foundational framework with septal cartilage

• Adding natural volume to the nasal tip with ear cartilage

• A soft, feminine nasal tip line

4. Correction of nasolabial angle

• Optimizing the angle between the nose and the upper lip

• Naturally improving the impression of a protruding mouth

• Refining the profile line to be sleek and soft

• Enhancing overall facial balance and proportions

5. Septoplasty

• Septal correction to address rhinitis

• Restoring internal nasal volume balance

• Improvement of breathing function

6. Inferior turbinoplasty

• Reduction of hypertrophic inferior turbinates

• Securing internal nasal airway space

• Addressing the root cause of nasal obstruction

1. Structural improvement

• Deviated nasal bones were accurately corrected for better symmetry

• The dorsal hump was naturally removed, creating a smooth nasal bridge

• Septal extension established a stable support framework for the nasal tip

2. Aesthetic improvement

• Front view: The crooked nose was straightened, creating symmetrical nasal lines on both sides

• Profile view: The drooping tip was appropriately elevated for a refreshed look, and nasolabial angle correction improved the appearance of a protruding mouth

• Nasal tip: A natural, feminine tip with an appropriate, unexaggerated angle

• Nasal bridge: The dorsal hump was removed, creating a smooth line

3. Functional improvement

• Internal nasal structures were improved through septoplasty

• Securing internal nasal airway space with turbinoplasty

• Smooth breathing through both sides

• Substantial improvement in chronic nasal obstruction

4. Overall harmony

• A natural nose that harmonizes with the entire face

• A refined, youthful look suited to the patient's age

• Balanced proportions that do not look excessive

In surgery to correct a drooping tip, setting the appropriate angle is essential. Elevating the tip too much can look unnatural and artificial, while elevating it too little may still leave a drooping appearance.

In this patient's case, the drooping tip was corrected via septal extension. Septal extension is a method that extends the septum—the central support structure of the nose—to elevate the nasal tip, yielding a very stable and natural outcome.

For this procedure, donor rib cartilage and septal cartilage were used together. Donor rib cartilage provides sufficient strength and volume, making it suitable as the foundational framework for septal extension. Septal cartilage harvested from inside the nose was utilized for supplementary support and natural tip contouring. Ear cartilage was then added to complete the smooth volume of the nasal tip.

The crooked dorsal hump was corrected with lateral osteotomy. Rather than simply filing down the hump, realigning the entire nasal bone framework is crucial to creating a symmetrical and natural bridge line.

Furthermore, nasolabial angle correction improved the impression of a protruding mouth. The nasolabial angle refers to the angle between the nose and the upper lip; when this angle is properly formed, the mouth appears less prominent from the profile view and the entire facial silhouette looks more refined.

Rhinoplasty is not merely about changing the height or shape of the nose; it must consider the balance and harmony of the entire face. Particularly in younger patients, achieving a refined outcome that remains natural and not overdone is vital.

I will continue to respect each patient's individuality and aesthetic goals, doing my utmost to create natural, harmonious noses. This has been Medical Director Dr. Peter C. Kang. Thank you.

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