Why the columella retracts and the alar rim looks pinched after rhinoplasty, and how autologous rib cartilage reconstruction is performed

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a revision rhinoplasty case of a patient who visited our clinic concerned about columellar retraction and a pinched alar appearance following a previous rhinoplasty.

The patient had undergone rhinoplasty about 5 years ago.

• About 5 years ago: Nasal bridge augmentation with a silicone implant, nasal tip surgery with donor rib cartilage, and unilateral osteotomy to correct nasal bone asymmetry. After that previous surgery, retraction in the columellar area and a pinched deformity of the right alar rim developed, leading the patient to decide on revision rhinoplasty.

The patient's specific requests were as follows:

• Improvement of the retracted columellar area

• Correction of the pinched appearance of the right alar rim

• Natural refinement of the overall nasal shape to balance the face

• Relief of nasal obstruction (rhinitis symptoms)

• Correction of the sunken appearance around both nasolabial folds (protruding mouth correction)

The patient expressed trust in Dr. Kang's recommendations for the overall nasal shape, and after considering replacing the donor rib cartilage from the previous surgery with autologous rib cartilage, ultimately chose autologous rib cartilage.

1. Removal of existing implant and graft material

• Removal of existing silicone implant

• Removal of the donor rib cartilage used in the previous surgery

• Detailed evaluation of deformed tissues

2. Anterior septal reconstruction (correction of columellar retraction)

• Identification of the damaged anterior septal cartilage causing the columellar retraction

• Sturdy reconstruction of the damaged anterior septum using autologous rib cartilage

• Restoration of columellar height and support

3. Reconstruction of the right alar rim

• Reconstruction of the pinched right alar rim using autologous rib cartilage

• Natural refinement of the alar contour through soft-tissue grafting

• Restoration of symmetry between both alae

4. Septoplasty and inferior turbinate reduction

• Internal nasal structures realigned by correcting the deviated septum

• Rhinitis symptoms improved by reducing hypertrophied inferior turbinates

• Restoration of breathing function

5. Paranasal augmentation (improvement of protruding mouth)

• Implant placement in both nasolabial fold areas

• Restoration of midface volume in sunken areas

• Improvement in protruding mouth appearance

Front view changes

• Natural restoration of the retracted columella

• Symmetric correction of the previously pinched right alar rim

• Overall balanced nasal shape

Profile view changes

• Restored columellar height creating a natural tip line

• Proper adjustment of the nasolabial angle

• Improvement of the protruding mouth as midface volume is restored with paranasal augmentation

Changes on the oblique view

• Natural nasal contour visible even at a 45-degree angle

• Clean nasal lines following correction of the alar deformity

• Improved overall facial balance through midface volume restoration

Changes in nostril shape

• Natural improvement of nostril shape following restoration of the retracted columella

• Restoration of symmetry between both nostrils after reconstructing the pinched right alar rim

• Overall neat and refined nasal base line

This is a revision rhinoplasty case involving columellar retraction and alar deformity following a previous surgery. A detailed analysis of why the columella had retracted revealed that damage to the anterior portion of the septal cartilage had weakened the structural support of the nasal tip as the root cause.

In such cases, simply raising the nasal tip is not sufficient; the core priority is first sturdily reconstructing the damaged anterior septum. In this surgery, autologous rib cartilage was used to reinforce the supporting framework of the anterior septum and naturally restore columellar height.

In addition, the pinched appearance of the right alar rim was corrected through alar reconstruction with autologous rib cartilage combined with soft-tissue grafting. Alar deformities are among the common issues encountered in revision surgery, and both cartilage and soft tissue must be supplemented simultaneously to achieve a natural, stable contour.

Septoplasty and inferior turbinate reduction were performed concurrently to relieve nasal obstruction, and paranasal augmentation was performed to supplement midface volume and address the sunken appearance around the nasolabial folds and the protruding mouth. In this way, during revision rhinoplasty, it is important to consider not only the nose itself but also its overall harmony with surrounding facial structures.

Because revision rhinoplasty must account for scar tissue, altered anatomy, and weakened structural support from previous operations, it demands far higher levels of diagnostic insight and surgical skill than primary surgery. Even in such complex revision cases, NOSELAB strives to accurately identify the root causes and provide fundamental solutions to achieve the intended result for every patient.

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

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