Why the nasal tip can remain upturned after revision rhinoplasty, and when donor rib cartilage is used

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce the case of a patient who visited our clinic after prolonged concerns about an upturned and deviated nose. Because the patient had faced complications during autologous rib cartilage harvesting in a previous surgery, this case required a meticulous approach planned with safety in mind using donor rib cartilage.

The patient had undergone two prior nasal surgeries.

• Approximately 10 years ago: Nasal tip plasty using septal cartilage (experienced heavy bleeding during surgery)

• Approximately 2 years ago: Revision rhinoplasty using autologous rib cartilage (developed a pneumothorax during rib cartilage harvest and received inpatient care)

Because a pneumothorax occurred during autologous rib cartilage harvest in the second surgery, the patient strongly preferred donor rib cartilage instead of autologous rib cartilage for this procedure.

• Improvement of the upturned appearance

• Correction of crooked nose

• Natural outcome without an implant (silicone)

• Burden regarding autologous rib cartilage harvesting → Desired use of donor rib cartilage

• Natural nasal tip line through nasolabial angle correction

Taking into overall account the patient's requests and previous surgical history, the surgery proceeded as follows.

1. Nasal tip reconstruction using donor rib cartilage

For this patient, who carried psychological trauma from autologous rib cartilage harvesting, donor rib cartilage was used as the primary material. Concurrently, the autologous rib cartilage placed during the previous surgery was carefully removed with minimal damage and repurposed as secondary material to realign the nasal tip.

2. Natural tip contouring and nasolabial angle correction

The upturned nasal tip was naturally lowered, creating a smooth line rather than a sharp point. The columellar width was slightly broadened to allow the columella to sit naturally lower, and the nasolabial angle was corrected to around 95 degrees to produce a refined profile line.

3. Asymmetry correction and nasal bridge contouring

The right nasal bone, which protruded and made the overall nose appear deviated, was delicately contoured. Additionally, to improve nostril asymmetry visible from the front, lowering of the nostril rim was performed using an additional cartilage graft on the right lower lateral cartilage.

Front view changes:

• The previously crooked bridge line was corrected into a straight alignment

• Nostril asymmetry noticeably corrected

• The nasal tip transitioned into a natural, soft shape

Profile view changes:

• The upturned tip was naturally lowered

• Nasolabial angle appropriately corrected, completing a refined profile

• A natural and stable nasal line achieved without implants

Nostril view changes:

• Difference in size between the left and right nostrils improved

• Balanced nostril shape as the columella descends naturally

In revision rhinoplasty, accurately assessing tissues and structural anatomy altered by prior surgeries is essential. In this case, having two prior surgical interventions and having experienced a pneumothorax during autologous rib cartilage harvesting imposed a significant emotional burden on the patient.

Donor rib cartilage can serve as a dependable alternative for such patients. It provides an adequate volume of cartilage without an autologous harvest procedure, satisfying both surgical stability and the patient's peace of mind. In addition, carefully repurposing the existing autologous rib cartilage secured an array of materials.

Implant-free surgery offers the advantage of natural results without the risk of implant-related side effects. However, because structural support and contouring must be achieved using cartilage alone, meticulous surgical planning and substantial experience are required.

We aim to deliver personalized surgical care tailored to each patient's individual condition and goals. I hope this case provides helpful insight for those facing similar concerns.

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

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