Why the nasal bridge looks wide and uneven, and how osteotomy and rib cartilage tip surgery are performed

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce a revision rhinoplasty case of a patient who desired a slim and prominent nasal appearance.

This was the patient's first rhinoplasty.

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

• A nasal bridge line closer to straight than a straight bridge line

• Desires overall nasal height augmentation

• Desire to eliminate the dorsal step-off

• A slim and sleek nasal bridge

• Preventing an upturned look

After analyzing the patient's requests and current condition, a comprehensive surgical plan was established.

1. Removal of foreign material from the nasal bridge

• Complete removal of foreign material previously in the nasal bridge

• Preparing a clean field for placing the new implant

2. Nasal tip surgery using donor rib cartilage

• Using donor rib cartilage together with a portion of septal cartilage

• Elevating the nasal tip cleanly for a defined, dramatic contour

• Long-term shape maintained with stable structural support

3. Lateral osteotomy

• Bringing the nasal bones inward to form a sleek nasal bridge line

• Achieving the slim nasal bridge desired by the patient

• Helps improve the dorsal step-off

4. Custom carving of the silicone implant

• Silicone implant precisely carved to fit the patient's nasal bone contours

• Detailed sculpting to match the nasal bone contours narrowed through osteotomy

• Achieving a smooth, nearly straight nasal bridge line

5. Nasolabial angle correction

• Adjustment of the angle between the nose and the lips

• A natural tip angle that does not look upturned

• Refined profile silhouette achieved

Front view changes:

• The nasal bridge is refined to be slim and sleek

• Overall refined and glamorous impression

• The dorsal step-off is smoothed out

Profile view changes:

• Achieved a nearly straight nasal bridge line

• Nasal tip elevated cleanly and prominently

• A natural angle that does not look upturned

• A refined profile through nasolabial angle correction

Overall changes:

• Overall nasal height is increased

• Achieved a slim, prominent nasal appearance

• Harmonious balance with the face

To create a slim and prominent look, it is important to secure bridge height while reducing bridge width. In this surgery, lateral osteotomy was performed to narrow the nasal bones into a sleek nasal bridge line, and the silicone implant was meticulously carved to fit the nasal bone contour, creating a smooth nasal bridge.

For the nasal tip, donor rib cartilage was used alongside a portion of septal cartilage to elevate and project it. Donor rib cartilage can be a suitable alternative for patients hesitant about harvesting autologous rib cartilage, and combining it with septal cartilage helps provide even more stable support.

Nasolabial angle correction was also performed to create the nearly straight nasal bridge line and non-upturned tip angle requested by the patient. The most essential aspect of rhinoplasty is accurately realizing the desired look while maintaining balance with the facial features.

I will continue to provide customized surgical care tailored to each patient. I hope this case helps those with similar concerns. This has been Dr. Peter C. Kang, Medical Director. Thank you.

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