Why small lower lateral cartilages cause a drooping tip: rib cartilage reinforcement and osteotomy methods

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce the case of a patient who visited our clinic concerned about a drooping nasal tip caused by very small lower lateral cartilages, as well as an uneven, crooked nasal bridge.

The patient was a primary rhinoplasty case who had never undergone any previous nasal surgery or procedures. Because the lower lateral cartilages were congenitally very small, structural support for the nasal tip was insufficient, leading to a drooping tip. Additionally, the nasal bridge had a dorsal hump and was crooked, creating an uneven and spread-out appearance that was a major concern for the patient.

The patient's specific requests were as follows:

• Natural nasal line

• Correction of the dorsal hump

• Elevating the drooping nasal tip to create a well-defined projection

• Open to using a silicone implant

The patient wanted an overall natural yet smooth nasal line, with the dorsal hump and drooping tip being the primary concerns. Because the lower lateral cartilages were very small, reinforcing the nasal tip with autologous rib cartilage was essential for this case.

1. Nasal tip plasty using autologous rib cartilage

• Using autologous rib cartilage to compensate for congenitally very small lower lateral cartilages

• Reinforcing the tip support structure to elevate the drooping nasal tip into a well-defined position

• Achieving natural nasal tip height and shape

2. Nasal bridge alignment via lateral osteotomy

• Nasal bone osteotomy to straighten the crooked bridge

• Repositioning the nasal bones to establish a straight bridge line

• Contributing to the improvement of the dorsal hump

3. Nasal bridge augmentation using a silicone implant

• Refining the uneven and wide bridge into a smooth contour

• Naturally correcting the dorsal hump area

• Precisely carving a silicone implant to match the nasal bones for a natural bridge line

4. Correction of nasolabial angle

• Appropriate adjustment of the nasolabial angle between the nasal tip and the upper lip

• Establishing a natural columellar line as the nasal tip is elevated

• Refined profile silhouette achieved

Front view changes

• The previously uneven bridge is corrected to become smooth and straight

• The overall wide appearance of the nose is refined and streamlined

• An overall balanced and natural nasal contour

Profile view changes

• The drooping tip is elevated into a well-defined projection using autologous rib cartilage

• The dorsal hump is smoothly corrected to create a gentle dorsal line

• Refined profile silhouette completed through nasolabial angle correction

Changes on the oblique view

• A natural and smooth nasal contour from a 45-degree angle

• Dorsal hump resolved into a smooth bridge line

• Harmonious transition between the nasal tip and bridge

Changes in nostril shape

• Nostril contours naturally improved as the nasal tip was elevated

• Balanced, symmetric nostril shape

• Overall neat and refined nasal base line

When the lower lateral cartilages are congenitally very small, structural support for the nasal tip is insufficient, resulting in a drooping or blunt tip. In such cases, simply suturing the tip cartilages together cannot achieve adequate correction, and the tip support structure must be fundamentally reinforced with a cartilage graft.

In this surgery, autologous rib cartilage was used to compensate for the deficient lower lateral cartilages and reinforce the support of the nasal tip. Autologous rib cartilage provides sufficient strength and flexibility, making it an excellent material for stably elevating the tip while achieving a natural shape.

The dorsal hump and crooked portion of the bridge were corrected using lateral osteotomy and a silicone implant. The nasal bones were repositioned with lateral osteotomy to straighten the crooked bridge, and the silicone implant was precisely carved to fit the nasal bones, improving the uneven, widened bridge into a smooth line.

An important aspect of dorsal hump correction is not simply shaving down the prominent area, but comprehensively considering the balance between the entire bridge line and the nasal tip. In cases like this, elevating the tip while correcting the hump allowed us to complete a smooth and natural nasal line overall.

We apply the most suitable surgical method by carefully analyzing each patient's cartilage condition and nasal anatomical characteristics. I hope this case serves as a helpful reference for anyone with similar concerns.

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

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