Why a nose operated on twice looks long and drooping, and how septal reconstruction using rib cartilage is performed

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce the case of a patient who came to our clinic after struggling for a long time with a long and drooping tip, a crooked bridge, and dorsal irregularity even after two prior rhinoplasty procedures.

• About 10 years ago: Rhinoplasty using silicone implant + ear cartilage → Decided on revision because the patient was dissatisfied with the shape

• January 2025: silicone implant + autologous rib cartilage (the patient had no functional discomfort)

• Improvement of dorsal bridge irregularities

• Refining the bulbous tip

• Correction of crooked nose

• Refining the columella line

• A well-defined and prominent nasal profile line

1. Septal reconstruction using autologous rib cartilage

• Because septal cartilage had been used excessively in previous surgeries, almost no cartilage remained.

• Autologous rib cartilage was harvested to reliably reconstruct the weakened septum.

• Securing stable support for the nasal tip

2. Safe removal of the protrusion on the right bridge

• Intraoperative findings confirmed that this was an autologous rib cartilage fragment inserted during a previous surgery to correct a depression.

• After safely removing the fragment, the depressed area was corrected by filling it naturally with cartilage and dermis.

3. Replacement of the bridge implant

• Removal of existing silicone implant

• A new implant was precisely carved to match the contours of the patient's nasal bone, naturally elevating the bridge.

4. Lateral nasal osteotomy

• Narrowing the wide and splayed nasal bones to create a sleek bridge line

• Achieved symmetry by correcting the deviated segment

5. Concurrent functional rhinitis surgery

• Improvement in nasal obstruction symptoms

• Restoration of breathing function

Front view changes:

• The wide and splayed bridge was narrowed to create a clean line.

• The crooked nose was straightened, securing symmetry.

• The bulbous tip was refined, adding three-dimensional definition.

Profile view changes:

• The drooping tip was slightly and naturally elevated, completing a prominent profile line.

• A natural height suited to the patient's facial features rather than an excessive elevation

• A smooth line achieved by resolving the uneven bridge

Nostril view changes:

• A refined columella line

• Improved balance between the left and right nostrils

• Natural refinement of the tip shape

Revision rhinoplasty requires a level of precision entirely different from a primary procedure. In particular, when a large amount of septal cartilage was harvested during previous surgeries, the lack of remaining cartilage makes it very difficult to secure stable support for the nasal tip.

In this type of case, we utilized autologous rib cartilage to reconstruct the weakened septum, firmly rebuilding the nasal central pillar. Furthermore, the protrusion on the right bridge was confirmed during surgery to be a cartilage piece placed previously; this was safely removed, and the depressed area was precisely corrected with cartilage and dermis.

The most important aspect of revision rhinoplasty is creating a natural line that matches the patient's tissue condition and facial structure rather than pursuing excessive height. To achieve a prominent yet natural result, customized planning that comprehensively takes into account the condition of remaining cartilage, skin thickness, and facial balance is essential. At the same time, it is also beneficial to address functional concerns such as nasal obstruction so breathing is made comfortable.

I will continue to provide customized surgeries that reflect each patient's individuality and requests through this meticulous approach. I hope this helps those with similar concerns.

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

#closedrhinoplasty #closedrevisionrhinoplasty #revisionrhinoplasty #autologousribcartilage #septalreconstruction #crookednosecorrection #droopingtip #bridgeimplantreplacement #rhinitissurgery #lateralosteotomy