Why a multiply operated nose deviates and develops a widened tip, and how cartilage is reconstructed

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who visited our clinic with concerns about a crooked nose and a widened nasal tip after undergoing several previous nasal procedures.

• 13 years ago: Rhinoplasty

• 8 years ago: Rhinoplasty and alar reduction using donor rib cartilage and a silicone implant

• 3 years ago: Revision rhinoplasty using donor rib cartilage and a silicone implant

Over the course of three surgeries, recurring compression of the nasal tip had emerged, accompanied by postoperative nasal obstruction.

The patient visited with the following concerns:

• Correction of crooked nose

• Correction of a widened, spread-out nasal appearance

• Natural straight bridge line

• A harmonious nose that complements the face

• A refined look without an overly sharp nasal tip

• Improvement in nasal obstruction symptoms

Surgical findings revealed severe damage to the septal cartilage caused by prior surgeries. In addition, the right lower lateral cartilage was almost completely missing, making structural reconstruction essential.

1. Septal cartilage reconstruction using autologous rib cartilage

• Stable reconstruction of the damaged septal cartilage using autologous rib cartilage

• Securing a stable support structure for the nasal tip

2. Reconstruction of the right lower lateral cartilage

• Reconstruction of the missing right lower lateral cartilage using autologous rib cartilage

• Restoration of nasal tip symmetry and shape

3. Implant replacement

• Removal of existing silicone implant

• Lowering the radix and carving a new implant tailored to the nasal bone before placement

• Formation of a natural bridge line

4. Correction of nasolabial angle

• Improvement of the profile silhouette

5. Functional improvement

• Improvement of nasal obstruction through septal correction and inferior turbinate reduction

Front view changes:

• The crooked nose was straightened

• The previously widened nasal tip was gathered into a refined shape

• A natural nasal line in harmony with the facial features

Profile view changes:

• Creation of a refined straight bridge line

• A clean profile achieved through nasolabial angle correction

• Natural bridge height created by adjusting the radix

Nostril view changes:

• Restoration of symmetry in an asymmetrical nasal tip

• An overall stable nasal tip shape

In patients who have undergone multiple procedures, cumulative damage to internal structures is common. In this case as well, damage to both the septal cartilage and lower lateral cartilage was quite advanced, making structural reconstruction essential rather than simple minor correction.

Autologous rib cartilage provides sufficient volume and rigidity in revision situations, making it a reliable material to reconstruct damaged structures stably. In particular, when lower lateral cartilage is missing, reconstruction using autologous tissue can support stable long-term results.

Addressing functional concerns such as nasal obstruction at the same time is vital to achieving both aesthetic satisfaction and functional improvement. I hope this case serves as helpful reference for those with similar concerns.

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

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