Why a nose appears long, drooping, and crooked: septal reconstruction and osteotomy

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a revision rhinoplasty case of a female patient in her 20s who visited our clinic after struggling with a long, drooping, and crooked nose for a long time.

The patient had previously undergone surgery to address functional nasal problems. However, the nasal obstruction was not sufficiently resolved after the procedure, and aesthetically, the long, drooping appearance of her nose remained unimproved, leaving her dissatisfied.

The main concerns the patient shared during the consultation were as follows:

• Noticeable asymmetry due to a crooked nasal axis

• Persistent, uncomfortable nasal obstruction even after the previous surgery

• A downward-drooping nasal tip that made her face appear elongated

• A request to simultaneously improve the elongated appearance of her midface

A detailed analysis of the patient's condition revealed a deviated septum with the septum shifted to one side, along with rhinitis. To resolve both the structural and functional issues at the same time, we formulated the following surgical plan:

1. Nasal tip plasty using autologous rib cartilage

• Elevating the drooping nasal tip to an appropriate height and angle, helping the midface appear shorter

• Securing stable structural support using autologous tissue

2. Partial septal reconstruction

• Correcting the septal deviation while shifting the septal cartilage to the right

• Addressing the root cause of the nasal obstruction

3. Lateral osteotomy of the nasal bones

• Straightening the crooked nasal bridge

• Establishing bilateral symmetry of the nasal bones

4. Correction of columellar tilt

• Repositioning the columella, which was tilted to the right, toward the center

• Achieving a balanced nasal contour from the front view

Front view changes:

• The nasal bridge, which had appeared crooked to one side, was straightened

• The columellar tilt was improved, resulting in a symmetrical nasal contour

• The overall look shifted to a more refined and neat impression

Profile view changes:

• The long, drooping nasal tip was lifted naturally

• The nasolabial angle was appropriately adjusted, helping the midface look shorter

• A refined profile, with the appearance of a protruding mouth noticeably softened

Functional improvement:

• Relief of nasal obstruction symptoms through correction of the deviated septum

• Airflow through both nasal passages became smooth

A long, drooping nose cannot be resolved simply by elevating the nasal tip. One must comprehensively evaluate the overall structure of the nose, particularly the condition of the septum and the alignment of the nasal bones.

In this type of case, because the internal structure was altered by prior surgery, establishing a new, stable support structure using autologous rib cartilage was key. Especially when accompanied by a deviated septum, aesthetic and functional improvements must be considered simultaneously; achieving harmony between both aspects leads to higher patient satisfaction.

Tissue conditions in revision rhinoplasty are less predictable than in primary surgery and require a delicate approach. I hope this case helps those who share similar concerns.

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

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