Why an upturned nose and unilaterally pinched nostril occur, and how implant-free reconstruction is performed

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who had undergone multiple surgeries for an upturned nose and nostril asymmetry without achieving satisfactory results. Excessive nostril show and a pinched appearance on one side had been long-standing concerns.

• 12 years ago: Cartilage tying surgery → nose became pinched and upturned

• 7 to 8 years ago: Filler injection at the radix

• 2 years ago: Ear cartilage surgery (nasal tip)

• 10 months ago: Nostril-lowering surgery (artificial dermis)

• Correction of upturned nose

• Reduction of excessive nostril show

• Softening pointed nostrils into a rounder shape

• Improvement of the pinched appearance

• Desire for natural materials without implants

1. Implant-free nasal bridge augmentation using donor rib cartilage and septum

• Utilizing donor rib cartilage and septal cartilage fragments

• Creating a natural bridge line without implants

• Material selection made to relieve the patient's concern regarding donor-site scarring

2. Correction of the upturned nose

• Repositioning the nasal tip

• Improving the upturned appearance by adjusting the nasolabial angle

• Reducing nostril show on the front view

3. Right nostril composite graft

• Performing a composite graft transplanting both skin and cartilage

• Lowering the pinched right nostril rim

• Correction of nostril asymmetry

4. Removal of existing foreign materials

• Removing artificial dermis and other foreign materials used in previous surgeries

• Building a new structure on a clean foundation

1. Frontal changes

• The upturned tip was naturally lowered

• Nostril show was noticeably reduced

• Pointed nostrils softened into a smoother shape

2. Profile changes

• A natural bridge line achieved even without implants

• The upturned appearance was corrected, creating a refined profile silhouette

• Overall facial balance improved through adjustment of the nasolabial angle

3. Nostril changes

• The pinched right nostril rim was lowered naturally

• Improvement of nostril asymmetry

• Better balance achieved between both nostrils

This patient was deeply troubled because multiple surgeries had failed to improve the upturned nose and nostril asymmetry. In particular, one nostril was visibly pinched, making the asymmetry prominent.

In this surgery, per the patient's request, I augmented the nasal bridge without artificial implants, using only donor rib cartilage and septal cartilage fragments. Implant-free surgery offers the advantage of achieving natural results without concerns regarding foreign body reactions.

In particular, the pinched right nostril was corrected using a composite graft containing both skin and cartilage. When lowering the nostril rim, transplanting skin along with cartilage provides a more stable and natural result than grafting cartilage alone. This also explains why the previous attempt using artificial dermis did not achieve adequate improvement.

In cases of multiple revision surgeries, tissue quality may be compromised, necessitating an even more meticulous approach. I removed the existing foreign materials and re-established the structural framework in a clean surgical field. I hope this case serves as a helpful reference for those struggling with unsatisfied outcomes from repeated surgeries for an upturned nose and nostril asymmetry.

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

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