Why the nasal tip turns upward and nasal obstruction occurs after multiple rhinoplasties: Autologous rib cartilage reconstruction

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce the case of a patient who visited our clinic concerned about an upturned nose and severe nasal obstruction after multiple rhinoplasties.

This patient had undergone multiple nasal procedures over an extended period.

• 12 years ago: Nasal filler injection

• 12 years ago: Rhinoplasty using a silicone implant and septal cartilage

• 6 months later: Revision rhinoplasty using a silicone implant and ear cartilage to return toward the preoperative state

• 5 years ago: Silicone implant removal

In particular, rhinitis worsened considerably after the last surgery, and nasal obstruction was causing significant discomfort in daily life.

The patient's primary concerns were as follows:

• Lowering the upward-rotated nasal tip

• Correcting excessive nostril show

• Improvement in nostril asymmetry

• Improving functional concerns such as nasal obstruction and rhinitis

During the consultation, I explained that lowering the nasal tip might make the nose appear longer. However, the patient preferred a slightly longer look, so we formulated the surgical plan accordingly.

1. Septal reconstruction using autologous rib cartilage

• Fundamentally restoring support to the weakened septum

• Naturally lowering the upturned nasal tip using septal extension

2. Crooked nose correction and septoplasty

• Restoring nasal symmetry by correcting the deviated septum

• Pursuing both functional and aesthetic improvements simultaneously

3. Concurrent rhinitis surgery

• Resolving the underlying cause of nasal obstruction

• Improving breathing function through inferior turbinate reduction

4. Nasal bridge reinforcement

• Creating natural height using autologous rib cartilage

• Achieved entirely with autologous tissue without artificial implants

5. Nasolabial angle correction and improvement of nostril asymmetry

• Improving the profile silhouette and creating the appearance of a less protruding mouth

• Achieving better symmetry between the left and right nostrils

Front view changes:

• The previously upturned nasal tip was brought down to an appropriate position

• Excessive nostril show was naturally reduced

• Nostril asymmetry was significantly improved

Profile view changes:

• The upturned tip was corrected, creating a refined nasal line

• Correcting the nasolabial angle visually softened the appearance of a protruding mouth

• Achieved the slightly longer, natural line that the patient desired

Functional changes:

• Secured structural stability of the nose through septal reconstruction

• Improved nasal obstruction by performing concurrent rhinitis surgery

In revision rhinoplasty for patients who have undergone multiple nasal surgeries, accurately evaluating the condition of the remaining tissue is paramount. When septal cartilage is severely damaged, as in this case, reconstruction using autologous rib cartilage is the most stable approach.

In particular, correcting an upturned nose cannot be accomplished simply by pulling the tip down; long-lasting results require first securing solid septal support before repositioning and re-angulating the nasal tip. By addressing both functional issues—nasal obstruction and rhinitis—along with aesthetics, we were able to achieve satisfying results in both form and function.

For anyone considering revision rhinoplasty, obtaining an accurate diagnosis of your current internal nasal structures is the essential first step. I hope this case helps those facing similar concerns.

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

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