Why the nose looks long and the nostrils look pinched after multiple rhinoplasties

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a revision rhinoplasty case of a patient who visited our clinic concerned about a long nose and nostril asymmetry.

In this type of case, the patient had a history of three prior nose surgeries:

• Around age 22: Alar reduction surgery

• Around age 26: Nasal bone osteotomy and silicone implant placement

• April 2023: Silicone implant replacement and nasal tip correction surgery

Through these repeated procedures, the nasal tip was excessively heightened, and excessive, asymmetrical alar reduction left the nostrils with a pinched appearance.

The patient wished to undergo an overall revision of the nose while addressing functional concerns as well. Experiencing rhinitis and nasal obstruction, the patient wanted aesthetic correction performed together with functional improvement, including septal correction and inferior turbinate surgery. Correction of the nasolabial angle was also requested to improve the profile line.

The core focus of this surgery was correcting the long nose and nostril asymmetry.

1. Reconstruction of the lower lateral cartilages using autologous rib cartilage

Because both lower lateral cartilages had been removed in previous operations, autologous rib cartilage was harvested to reconstruct the lower lateral cartilages.

2. Adjusting nasal tip height and preventing a bulbous appearance

While lowering the excessively raised tip height, the design slightly widened the tip width to prevent worsening a bulbous look, drawing visual focus from the alae to the nasal tip.

3. Correction of nostril asymmetry

The nostril asymmetry caused by overly aggressive, asymmetrical alar reduction was corrected as much as possible.

4. Correction of the long nose

Lowering the radix corrected the elongated appearance, and the nasolabial angle was improved at the same time.

5. Functional surgery

Deviated septum and rhinitis were corrected, and right external nasal valve stenosis was relieved, improving symptoms of nasal obstruction simultaneously.

Front view changes:

• Improvement in the asymmetry of the pinched nostrils

• Improved balance with the nasal tip adjusted to a natural width

Profile view changes:

• Excessively high nasal tip adjusted to an appropriate height

• Refined profile silhouette achieved through nasolabial angle correction

• Elongated impression resolved by adjusting the radix

Nostril view changes:

• Natural nostril shape achieved through correction of left-right asymmetry

• Softer impression with relief of the pinched appearance

Cases of revision rhinoplasty where the lower lateral cartilages have been lost from previous surgeries are among the most challenging. When structural support is absent, implants alone cannot support a stable result.

For this type of presentation, a structural approach was taken to reconstruct the lost cartilage using autologous rib cartilage. While lowering the nasal tip height, the tip width and visual focus were meticulously adjusted to prevent an accentuated bulbous look, and adjusting the radix addressed the appearance of an elongated nose.

In addition, resolving functional issues simultaneously—such as septal deviation, rhinitis, and external nasal valve stenosis—improved both form and function. In revision rhinoplasty, accurately assessing the status left by prior operations and establishing an appropriate reconstructive plan is paramount.

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

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