Why noses become short and upturned after multiple revision surgeries, and methods for reconstruction

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce the case of a patient who visited our clinic concerned about a short, upturned nose after undergoing multiple prior nasal surgeries.

The patient had previously undergone multiple procedures on the face and nose.

• Approximately 17 years ago: Rhinoplasty using a silicone implant and ear cartilage (the implant later shifted and deviated)

• Approximately 15 years ago: Rhinoplasty using a silicone implant and ear cartilage (the nasal tip gradually lost height)

• Approximately 12 years ago: Rhinoplasty using a silicone implant and ear cartilage (insufficient nasal tip height)

• Approximately 12 years ago: Two-jaw surgery

• Approximately 10 years ago: Surgery with a silicone implant alone (implant mobility)

• Approximately 3 years ago: Rhinoplasty using autologous rib cartilage and a silicone implant

• Recently: Philtrum reduction at another medical institution

• Desire to naturally lower the upturned nasal tip

• Desire to reduce nostril show from the front view

• Desire for a balanced nasal profile by lowering the columella

With the tissues weakened from multiple revision surgeries, the patient hoped for a change planned with safety in mind while remaining natural.

1. Septal cartilage reconstruction using autologous rib cartilage

• Due to prior surgeries, virtually no septal cartilage remained, leaving the nasal tip short and upturned.

• Autologous rib cartilage was harvested from the patient to rebuild the septal cartilage and restore support to the nasal tip.

2. Left internal nasal mucosal advancement flap

• To compensate for the shortage of internal nasal skin, an advancement flap was performed using the mucosa from inside the left nostril to cover the defect.

3. Precise adjustment of the nasal bridge implant

• The silicone implant was sculpted precisely to match the contour of the patient's nasal bone, creating a natural dorsal line.

4. Functional surgery for nasal obstruction relief

• Septoplasty and turbinate (rhinitis) surgery were performed concurrently to improve respiratory function.

Front view changes

• The upturned nasal tip was naturally lowered

• Excessive nostril show was reduced

Profile view changes

• The short nasal length was elongated in balanced proportion

• The underprojected nasal tip was corrected to an appropriate height

• The columella was lowered, creating a smooth profile line

Overall change in impression

• A stable impression achieved through a dorsal line fitted to the nasal bone structure

• Nasal obstruction improved, making breathing significantly more comfortable

In noses that have undergone multiple revision surgeries, available cartilage and soft tissue are often severely depleted. In particular, when the septal cartilage is damaged with little remaining, the nasal tip becomes short and upturned; attempting excessive correction in this state can lead to subsequent deformities or functional complications.

In this clinical presentation, the septum was reliably reconstructed using the patient's own autologous rib cartilage, and the mucosal deficiency was replenished with an advancement flap, allowing the upturned nasal tip to be lowered safely. In addition, by meticulously carving the nasal bridge implant to fit the nasal bone contour and performing septoplasty and rhinitis surgery together, aesthetic improvement and restoration of respiratory function were achieved simultaneously.

In revision rhinoplasty, a tailored approach that comprehensively evaluates the amount of residual cartilage, tissue condition, and skin thickness is paramount. NOSELAB will continue to resolve patients' concerns safely through this careful approach.

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

#closedrhinoplasty #closedrevisionrhinoplasty #autologousribcartilage #septalreconstruction #shortnosecorrection #upturnednosecorrection #revisionrhinoplasty #nasalobstructionsurgery #columellacorrection