Why a nose operated on multiple times continues to appear upturned, and how septal reconstruction is performed

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who visited our clinic concerned about an upturned nasal tip and nostril asymmetry that persisted despite multiple previous operations.

The patient presented a complex history involving several surgical procedures:

• 4 to 5 years ago: Nasal bridge silicone implant, nasal tip autologous rib cartilage graft, and osteotomy

• 2 years ago: After double-jaw surgery: nasal bridge silicone implant, nasal tip ear cartilage and fascia graft, nasolabial angle correction, lowering the alar rims, philtrum reduction, and alar reduction

Despite these multiple procedures, the sharp, upturned tip remained unresolved, with persistent contracture of the columella and nostril asymmetry.

The patient's specific requests were as follows:

• Correction of the upturned nasal tip

• Reduced nostril show on the front view

• Achieving a rounded yet refined, natural-looking tip along a straight bridge line

• Resolving contracture in the columella

1. Septal reconstruction using donor rib cartilage

Because damage to the septal cartilage was severe, relying solely on autologous cartilage would not provide sufficient support. Using donor rib cartilage, a sturdy support framework was built to secure long-term structural stability.

2. Bilateral lower lateral cartilage reconstruction

The lower lateral cartilages weakened by prior procedures were reconstructed, simultaneously improving tip contour and structural support.

3. Dermis-fat composite graft to the right soft triangle

The soft triangle area causing nostril asymmetry was reinforced. Grafting dermis together with fat provided natural volume and improved symmetry.

4. Upturned nose correction and nostril asymmetry improvement

Relying on the reconstructed support framework, the nasal tip angle was carefully adjusted, and nasolabial angle correction created a natural lateral profile.

Front view changes

• The upturned nasal tip was lowered to a natural angle

• Nostril show was noticeably reduced

• The previously sharp nasal tip changed to a rounded, refined contour

• Nostril asymmetry was improved, creating a balanced front view

Profile view changes

• A refined nasal silhouette following a straight bridge line

• A natural lateral profile achieved by properly adjusting the nasolabial angle

• Nasal tip height and angulation harmonizing naturally with the face

Changes in nostril shape

• Significantly improved symmetry between the left and right nostril size and shape

• Reinforcement of the soft triangle maintains stable nostril contours

• Columellar contracture was resolved, restoring natural nostril shapes

In this challenging revision case, repeated surgeries had severely damaged the septal cartilage, compounded by weakened lower lateral cartilages and marked nostril asymmetry.

Especially when septal cartilage damage is severe, autologous cartilage alone is often insufficient for complete reconstruction, making donor rib cartilage a safe and suitable option. Donor rib cartilage provides ample material, offering the advantage of reconstructing the septum and reinforcing the lower lateral cartilages simultaneously.

In addition, a dermis-fat composite graft to the soft triangle serves as a precise method for correcting nostril asymmetry. Rather than placing cartilage alone, it adds natural soft-tissue volume, making it effective for detailed adjustment of the nostril contour.

The most crucial aspect of revision rhinoplasty is accurately assessing the structures altered by previous surgeries and rebuilding a stable support framework. Even in such complex revision cases, NOSELAB focuses on addressing patient needs thoroughly to provide satisfying outcomes.

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

#closedrhinoplasty #closedrevisionrhinoplasty #upturnednosecorrection #nostrilasymmetry #donorribcartilage #revisionrhinoplasty #septalreconstruction #lowerlateralcartilagereconstruction