Why the nasal tip turns upward when the septum is lost, and how to reconstruct the septum with autologous rib cartilage

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who visited our clinic concerned about a severely upturned nasal tip and pinched-looking alae after the anterior portion of the septum had been completely removed during previous surgery.

The patient had a history of 2 previous rhinoplasty procedures.

• Approximately 21 years ago: Rhinoplasty using a silicone implant and ear cartilage

• Approximately 2 years ago: Revision rhinoplasty using a silicone implant and autologous rib cartilage

Notably, during the previous surgery, the anterior portion of the septum had been completely removed and harvested as graft material. Because the septum is the core support structure holding up the nasal tip, its loss severely weakened tip support, causing the nasal tip to become noticeably upturned. In addition, the alae appeared pinched on both sides and both sides of the nasal bridge were depressed, leaving the patient dissatisfied with the overall nasal appearance.

The patient's specific requests were as follows:

• Correction of the upturned nasal tip

• Correction of the pinched-looking alae

• Desire to reduce nostril show

• Overall correction of the crooked nose

• Improvement of nasal obstruction

When the septum is lost, revision rhinoplasty is not merely a matter of reshaping the nose; it is closer to a reconstructive procedure that must build a new core support structure. I explained this thoroughly to the patient and designed a surgical plan centered on septal reconstruction using autologous rib cartilage.

1. Septal reconstruction using autologous rib cartilage

• Reconstruction of the anterior septum, which was completely removed in previous surgery, using autologous rib cartilage

• Creation of a new core support framework for the nasal tip to correct the upturned tip

• Securing structural stability of the septum to support a stable long-term result

2. Alar reinforcement using autologous rib cartilage

• Reinforcement of the bilaterally pinched alae with autologous rib cartilage

• Restoration of natural alar curvature

• Reduction of nostril show to achieve a more stable frontal appearance

3. Filling depressed bridge areas with micro-particulate autologous rib cartilage

• Processing autologous rib cartilage into fine micro-particles

• Spreading and filling the depressed areas on both sides of the bridge to create a smooth dorsal line

• Restoration of a natural bridge contour

4. Corrective surgery for deviated septum and rhinitis

• Straightening the deviated septum through septoplasty

• Alleviating rhinitis symptoms through inferior turbinate reduction

• Breathing function normalized through relief of nasal obstruction

Front view changes

• The previously upturned nasal tip is lowered to a natural position, creating a stable shape

• The pinched-looking alae are reinforced with natural curvature

• Reduced nostril show provides a more relaxed, balanced frontal impression

Profile view changes

• Lowering the upturned tip establishes a natural nasal profile line

• Septal reconstruction secures a stable support structure for the nasal tip

• An overall balanced lateral silhouette

Changes on the oblique view

• Natural transition between the nasal bridge and nasal tip from the 45-degree angle

• Depressed areas on both sides of the bridge are smoothly filled

• An overall soft and natural nasal contour

Changes in nostril shape

• The pinched alae are reinforced, restoring a natural nostril shape

• Excessive nostril show improves as the nasal tip is brought down

• Balanced, symmetric nostril shape

This was a highly challenging revision rhinoplasty case where the anterior septum had been completely excised in previous surgery. The septum is the foundational pillar supporting the nasal tip; when this structure is lost, tip support drops sharply, resulting in problems such as an upturned or collapsed tip.

In cases of septal loss like this, simply refining the external shape of the tip cannot provide a fundamental solution. Only by reconstructing the septum, the nose's core support pillar, can we prevent the tip from turning upward or deforming again. In this surgery, we precisely reconstructed the missing septal segments with autologous rib cartilage, establishing a stable structural foundation for the nasal tip.

Furthermore, both alae appeared pinched as a consequence of previous surgery. We reinforced the alar structures with autologous rib cartilage to restore natural curvature. For the depressions on both sides of the bridge, we finely diced autologous rib cartilage and spread it evenly to build a smooth dorsal line.

Revision rhinoplasty after septal loss requires far greater surgical skill and experience than standard revision cases. This is because a substantial amount of structural framework must be rebuilt under compromised conditions, including preexisting scar tissue and decreased vascularity. Even in such complex reconstructive cases, NOSELAB thoroughly analyzes each patient's structural status to deliver the intended result.

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

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