Why a nose can look short and upturned after repeated surgeries, and how rib cartilage tip extension works

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a revision rhinoplasty case of a male patient who was dissatisfied with his nose looking short and upturned after previous surgeries.

About 2 years ago, the patient underwent rhinoplasty using a silicone implant and donor rib cartilage, along with osteotomy and deviated septum correction. Later, feeling that the nose was excessively high, he underwent revision surgery about 1 year ago to remove the silicone implant and use new donor rib cartilage. However, after going through two surgeries, the nose became short, upturned, and feminine in appearance, which led him to visit NOSELAB to address this concern.

The patient's primary concerns were as follows:

• Improvement of the lowered nasal bridge after silicone implant removal

• Correction of wide nasal bones seen from the front

• Desire to reduce noticeable nostril show

• Open to using a silicone implant to achieve a masculine straight nose

He wanted a distinct design change from an overall short, upturned, and feminine nose to a masculine line.

After thoroughly analyzing the patient's requests and the current condition of the nose, surgery was performed through a closed approach as follows.

1. Nasal tip extension and structural reinforcement using autologous rib cartilage

• Naturally lengthening the nose to address the shortened appearance

• Lowering the upturned nasal tip to secure a masculine line

2. Restoring overall nasal bridge height

• Building overall height from the lowered glabella along the bridge

• Achieving a defined yet natural straight line

3. Maintaining a 90-degree nasolabial angle

• Setting the nasolabial angle to 90 degrees, a key element of a masculine impression

• Creating a straight nasal line extending forward without an upturned look

4. Improving nasal bone width and nostril show

• Correcting the wide-looking nasal bones

• Reducing nostril show to establish balance on the front view

1. Frontal changes

• A wide-looking nose transformed into a slim, masculine line

• Reduced nostril show creating a neater, refined impression

2. Profile changes

• The short, upturned nose improved into a naturally lengthened, straight line

• Maintaining a 90-degree nasolabial angle completing a masculine, refined profile

• Securing overall height from the glabella to the nasal tip

3. Nostril changes

• Reduced nostril show as the upturned nasal tip is lowered

• A natural and balanced contour on the front view

The most important aspect of male revision rhinoplasty is accurately understanding and realizing the masculine aesthetic desired by the patient. Unlike female rhinoplasty, key priorities in male rhinoplasty are maintaining the nasolabial angle around 90 degrees and highlighting a straight bridge line.

Particularly in cases of repeated revisions, preexisting tissues may be unstable, making it essential to firmly support the framework using reliable materials such as autologous rib cartilage. In this type of case, utilizing autologous rib cartilage allowed us to transform a short, upturned nose into a masculine straight nose while preserving natural contours.

Because surgical approaches in revision rhinoplasty differ significantly depending on past surgical history and tissue condition, an accurate diagnosis and a customized plan fully reflecting the patient's requests are essential.

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

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