Why a nose becomes upturned and the columella retracts after repeated revisions, and how to reconstruct the septum

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 an upturned nose and nostril asymmetry that persisted even after multiple rhinoplasty procedures.

• About 10 years ago: Rhinoplasty was performed at another clinic using a silicone implant, ear cartilage, and septal cartilage, but the patient was dissatisfied with the shape.

• 2022: Rhinoplasty was performed at another clinic using a silicone implant and autologous rib cartilage.

• 2024: Revision surgery was performed at another clinic to cover an area where the silicone implant showed through.

As multiple surgeries accumulated, the internal nasal structures had weakened, and cosmetic satisfaction had also declined.

The patient wanted to naturally lower the retracted columella. The patient also wished to correct the unnaturally upturned nasolabial angle and improve the asymmetry between both nostrils. There was no major breathing difficulty.

1. Reconstruction of the anterior septum — In previous surgery, the anterior portion of the central partition cartilage (septal cartilage) had been excessively excised, and the autologous rib cartilage grafted in that space had collapsed inward. Using the existing autologous rib cartilage, the anterior septal structure was reconstructed solidly once again.

2. Reconstruction of tip shape — Using donor rib cartilage, the collapsed nasal tip was rebuilt naturally and stably.

3. Correction of the upturned nose — The excessively upturned nasal tip position was lowered downward, and the retracted columella was naturally brought down to harmonize the nasolabial angle.

4. Correction of nostril asymmetry — The asymmetry of the nostrils visible from the front was caused by the lower lateral cartilage being tied asymmetrically to one side. This area was released and corrected symmetrically.

5. Replacement of the nasal bridge implant — After removing the existing implant, a new silicone implant was custom-designed and inserted to create the patient's desired line, featuring a high dorsum with a nasal tip that slopes slightly downward.

Front view changes:

The asymmetry of both nostrils was improved, giving a more balanced impression, and the line of the nasal bridge became well-defined.

Profile view changes:

As the excessively upturned nasal tip was lowered, the nasolabial angle became natural, creating a profile where the dorsum is high and the nasal tip transitions smoothly downward.

Nostril view changes:

With the collapsed columella naturally lowered, the nostril shapes viewed from the front and base settled into a much more balanced contour.

In revision rhinoplasty performed after multiple surgeries, stably restoring collapsed structures is far more critical than simply refining the shape. In particular, when the anterior septum is weakened, it easily leads to deformities such as a collapsed tip or an upturned nose.

In cases like this, preserving the existing autologous rib cartilage as much as possible to reconstruct the septum, while reinforcing insufficient areas with donor rib cartilage, secures structural stability while achieving a natural contour. In revision surgery, accurately assessing the condition of remaining tissue and previous surgical interventions, and carefully tailoring materials and techniques to the patient's nasal anatomy, determines the outcome.

I will continue to provide customized surgeries with this cautious approach, fully reflecting each patient's concerns and goals. I hope this case helps those with similar concerns.

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

#closedrhinoplasty #closedrevisionrhinoplasty #revisionrhinoplasty #upturnednosecorrection #nostrilasymmetry #autologousribcartilage #donorribcartilage #nasolabialanglecorrection #implantremoval #septalreconstruction