Why nostrils become asymmetrical and the nose looks crooked, and how rib cartilage reconstruction is performed

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a revision rhinoplasty case of a patient who visited our clinic after suffering for a long time from nostril asymmetry and a crooked nose.

The patient had undergone rhinoplasty about 16 years earlier using a Gore-Tex implant and ear cartilage.

The patient had the following concerns:

• Improving nostril asymmetry

• Correction of crooked nose

• Lowering the radix, which appeared too high, to achieve a natural look

• A soft, feminine, and refined nasal profile

• A harmonious nose that complements the face

In addition, functional improvement was planned because the patient experienced bilateral nasal obstruction.

1. Closed revision rhinoplasty using autologous rib cartilage

The Gore-Tex implant placed during the previous surgery was removed, and the overall nasal framework was restructured.

2. Correction of nostril asymmetry

Structural instability had developed because almost none of the right lower lateral cartilage remained from the previous surgery. The right lower lateral cartilage was reconstructed using autologous rib cartilage to restore balance between both sides.

3. Correction of crooked nose

The columella was tilted to the left due to a deviated septum, which contributed to the nostril asymmetry. The septal cartilage was straightened to align the central axis of the nose.

4. Natural correction of the nasal bridge

A silicone implant was precisely sculpted to fit the shape of the patient's nasal bone, naturally elevating the bridge. By lowering the radix, the transition line from the forehead to the nose was smoothly connected.

5. Functional improvement

Septoplasty and inferior turbinate reduction were performed together, resolving the symptoms of nasal obstruction.

Front view changes:

• The nostril asymmetry improved, restoring balance between both sides. The crooked appearance of the nose was straightened.

Profile view changes

• The nasal bridge, which previously started excessively high, now begins at a natural position, creating a soft line. A feminine and refined profile was achieved.

Changes in nostril shape

• The size of both nostrils became symmetrical. The columella, which had been tilted to the left, was centered.

Correcting nostril asymmetry in revision rhinoplasty is technically challenging. In particular, when cartilage tissue has been lost due to prior surgery, a simple correction cannot provide a fundamental solution.

In this type of case, nostril asymmetry developed from a combination of lost right lower lateral cartilage and a deviated septum. We addressed the structural cause by reconstructing the missing cartilage with autologous rib cartilage and straightening the septum.

Furthermore, by naturally adjusting the radix, we achieved the soft, feminine nasal line the patient desired. Functionally, nasal obstruction was also resolved, making this a case that achieved both aesthetic and functional satisfaction.

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

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