Why bulbous tip returns after tip surgery with ear cartilage and reconstruction methods

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a revision case of a patient who visited our clinic due to concerns about a bulbous and upturned-looking nose.

About 3 years ago, the patient had undergone nasal tip surgery using ear cartilage and alar reduction at another medical clinic. Even after the surgery, the bulbous appearance of the nasal tip remained, and because the upturned look on the profile view had not improved, the patient decided to undergo revision rhinoplasty.

The patient stated wanting improvement in the following areas:

• Improving the flared, wide appearance of the bulbous tip

• Correcting the upturned appearance of the nasal tip from the profile view

• Improving the overall nasal line

• Achieving a feminine and refined straight bridge line

• The patient requested the use of autologous rib cartilage for the nasal tip and agreed to the use of an implant for the nasal bridge.

The key was reconstructing the nasal tip structure that was not adequately corrected in the previous surgery.

1. Septal extension using autologous rib cartilage

• Reinforcing the nasal tip support structure weakened by the previous surgery

• Stably securing nasal tip height and length

2. Structural approach for bulbous nose correction

• Partially removing scar tissue remaining in the nasal tip

• Repositioning and suturing the lower lateral cartilages to create a well-defined nasal tip

• Bringing together the nasal tip that had appeared flared and bulbous

3. Forming the nasal bridge line

• Finely carving the silicone implant to match the shape of the nasal bone

• Naturally raising the nasal bridge to achieve a feminine straight bridge line

Front view changes

• The flared, bulbous nasal tip was brought together into a defined shape

• The bulbous impression significantly improved, creating a more refined look

• The overall nasal width was reduced, enhancing balance with the face

Profile view changes

• The upturned nasal tip was corrected to an appropriate angle

• Forming a smooth straight bridge line connecting the nasal bridge to the tip

• Achieving a feminine and natural profile silhouette

Revision surgery begins with accurately identifying the tissues and structures altered by previous surgeries. In particular, when the nasal tip is operated on using only ear cartilage, it is not uncommon for structural support to weaken over time, causing the nasal tip to revert to a bulbous shape.

In these cases, firmly reconstructing the nasal tip support structure using autologous rib cartilage was key. Rib cartilage has superior strength and support compared to ear cartilage, making it advantageous for maintaining the shape of the nasal tip over a long period. In addition, by complementing the nasal bridge line with an implant, we were able to naturally achieve the feminine straight bridge line the patient desired.

I hope this is helpful to those considering revision surgery. This was Dr. Peter C. Kang, Medical Director. Thank you.

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