Why the nasal tip can look bulbous and crooked after rhinoplasty with ear cartilage

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who visited our clinic because they were dissatisfied with the outcome of their previous rhinoplasty. Following the prior surgery, the patient was troubled by a nasal tip that appeared bulbous, drooped, and slightly deviated to the right, along with symptoms of nasal obstruction.

• Approximately 3 years ago: Previous rhinoplasty (silicone implant, ear cartilage, septoplasty, and concurrent rhinitis surgery)

• Approximately 3 years ago: Filler injection to the forehead and glabella (not removed during the previous rhinoplasty)

• Preference for a distinct, defined nasal line

• Correction of the bulbous and drooping nasal tip

• Correction of the rightward deviation

• Relief of nasal obstruction (accompanied by rhinitis)

Septal reconstruction using autologous rib cartilage

• Using the patient's own rib cartilage, the weakened septum was reinforced and reconstructed. A solid structural framework was established to prevent the nasal tip from drooping, resulting in a well-projected, distinct tip line.

Adjustment of the nasal bridge line using a silicone implant

• The implant was precisely carved to fit the contour of the nasal bones, naturally realizing the defined bridge line the patient desired.

Septoplasty

• The deviated septum was straightened to correct the appearance of rightward deviation and to improve internal nasal airflow.

Rhinitis surgery (turbinate surgery)

• The hypertrophied inferior turbinates were precisely trimmed to relieve nasal obstruction and help breathing feel considerably more comfortable.

Correction of the nasolabial angle

• The angle above the philtrum was refined to improve the profile line and restore balance between the nasal tip and the lips.

Front view changes

• The bulbous nasal tip is narrowed and well-defined

• The rightward deviation is corrected, establishing stable bilateral symmetry

• The nasal bridge line appears clean and well-defined

Profile view changes

• The drooping nasal tip is naturally elevated

• A distinct yet natural straight bridge line is formed

• The nasolabial angle is refined, giving the profile a more sophisticated contour

Overall change in impression

• The septum is straightened, significantly relieving nasal obstruction

• Rhinitis symptoms are alleviated

• Breathing has become more comfortable

Revision rhinoplasty is far more complex than primary rhinoplasty. Because the septum is often weakened or thick scar tissue has formed after the first procedure, it is difficult to achieve a satisfactory outcome simply by adjusting the external shape. In this case as well, septal support was inadequate, so the foundational structure of the nose was rebuilt from the base using autologous rib cartilage.

Furthermore, for patients who also experience nasal obstruction, aesthetic correction alone cannot improve their quality of life. Pursuing both cosmetic and functional outcomes simultaneously is the core principle of closed revision rhinoplasty. In this case, septoplasty and rhinitis surgery were performed concurrently to help restore comfortable breathing.

Autologous rib cartilage carries a low risk of foreign body reaction and provides sufficient structural strength, making it a reliable material for reconstructing a weakened nasal framework. Even for patients seeking a more pronounced nasal line, utilizing autologous tissue supports a stable long-term result.

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

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