Noses with an arrow nose and bulbous tip: why we start with septal reconstruction

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce a revision rhinoplasty case of a patient whose septum was severely damaged from previous surgeries and who was also suffering from nasal obstruction.

In this type of case, the patient had undergone rhinoplasty twice before.

• Approximately 7 years ago: First rhinoplasty using Alloderm, ear cartilage, and a silicone implant

• Approximately 3 years ago: Silicone implant replacement, Alloderm removal, and functional nasal surgery

However, the septum was severely damaged due to these prior surgeries, and nasal obstruction persisted, making revision surgery necessary.

When the patient visited our clinic for consultation, the requests were as follows:

• Correction of the arrow nose (especially noticeable when smiling)

• Improvement of bulbous nose

• To make the midface appear shorter

• Desires overall nasal height augmentation

• Preference for a defined, dramatic nasal line

In particular, the patient was deeply concerned about the arrow nose and bulbous tip, and desired a distinct yet harmonious nose that complements the facial features.

Preoperative nasal endoscopy and CT scans performed at our clinic confirmed a deviated septum and rhinitis. Accordingly, we established a comprehensive surgical plan to address aesthetic and functional improvements simultaneously.

1. Septal reconstruction using autologous rib cartilage

• Reconstruction of the severely damaged septum from previous surgeries using autologous rib cartilage

• Securing a stable support structure to firmly elevate the nasal tip

• Structural reinforcement to maintain long-term structural stability

2. Septal extension

• Extending the nasal tip based on the reconstructed septum

• Correction of the arrow nose and visual reduction of midface length

• Creating a well-defined yet natural tip line

3. Bulbous tip correction

• Refining a blunt, wide nasal tip into a slender contour

• Repositioning and trimming the nasal tip cartilages

• Creating an overall refined nasal shape

4. Correction of nasolabial angle

• Adjustment of the angle between the nose and the lips

• Improvement of the accentuated arrow nose appearance when smiling

• Refined profile silhouette achieved

5. Septoplasty

• Correction of the deviated septum confirmed on CT imaging

• Straightening the deviated septum to resolve nasal obstruction

• Normalizing airflow within the nasal cavity

6. Rhinitis surgery

• Reduction of hypertrophic inferior turbinates

• Relief of nasal obstruction caused by chronic rhinitis

• Restoration of comfortable breathing function

Front view changes:

• Bulbous tip refined into a sleeker contour

• Nasal tip elevated cleanly and prominently

• An overall defined and sophisticated impression

Profile view changes:

• Arrow nose corrected to create a natural nasal tip line

• Visual shortening effect on the midface through nasolabial angle correction

• Natural nasal contour maintained even when smiling

Functional changes:

• Relief of nasal obstruction symptoms through septoplasty

• Comfortable breathing restored with rhinitis surgery

• Aesthetic satisfaction and functional improvement achieved simultaneously

In revision rhinoplasty, when the septum is severely damaged from previous procedures, simply altering the external shape has clear limitations. Attempting to build up the nasal tip over a compromised septum can lead to nasal collapse or deviation over time.

In such presentations, we securely reconstruct the damaged septum using autologous rib cartilage and reliably elevate the nasal tip on that foundation. Because autologous rib cartilage is the patient's own tissue, it is safe with no risk of foreign-body rejection, and its strong support helps maintain a stable shape over the long term.

Furthermore, by accurately diagnosing the deviated septum and rhinitis through preoperative nasal endoscopy and CT scans at our clinic, we also performed functional nasal surgery to resolve the nasal obstruction. In revision rhinoplasty, it is essential to identify the underlying issues through precise diagnostic evaluations and establish a tailored surgical plan.

We will continue to provide surgery planned appropriately for each individual patient's condition. I hope this case serves as a helpful reference for those facing similar concerns. This was Dr. Peter C. Kang, Medical Director. Thank you.

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