Why a narrow nasolabial angle with a dorsal hump makes the mouth appear protruding and how to correct it

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a closed rhinoplasty case using autologous rib cartilage for an international patient who desired a natural yet refined, distinct nasal line.

The patient was an international patient visiting for their primary rhinoplasty.

Looking at the preoperative condition, the nasal bridge was uneven with visible irregularities, and the prominent dorsal hump gave the overall nose a somewhat heavy, coarse impression. Additionally, the angle where the nose meets the upper lip (nasolabial angle) was narrow, making the mouth appear relatively protruding. The nasal tip was low and lacked volume, leaving room for improvement in harmony between the nose and face on profile view.

• Desired a natural yet distinct and refined nasal line

• Desired a smooth dorsal line by shaving the uneven nasal bridge and dorsal hump

• Desired to naturally raise the nasal tip using autologous rib cartilage

• Desired to improve the appearance of a protruding mouth by correcting the nasolabial angle

1. Dorsal hump correction and bridge implant placement: After shaving down the irregular dorsal hump on the nasal bridge, a silicone implant was precisely carved to match the contours of the nasal bone and placed along the dorsum. Using an implant sculpted precisely to the nasal bone created a natural dorsal line.

2. Septal reconstruction: By stably reconstructing the internal septal structure (the dividing partition inside the nose), we secured a firm support structure to uphold the nasal tip. The septum plays a pivotal role in tip shape, height, and long-term structural maintenance.

3. Nasal tip plasty using autologous rib cartilage: Using a closed approach, the patient's own rib cartilage was used to elevate the nasal tip and delicately shape it in the desired direction. Because autologous tissue is used, a natural outcome without foreign body reaction can be expected.

4. Nasolabial angle correction: By correcting the angle between the nose and the upper lip, the lower part of the nose was given a gentle, natural upward tilt. Through this, the appearance of a protruding mouth was improved from both the front and profile views, establishing a balanced proportion between the nose and lips.

Front view changes

• The nasal bridge became smooth and straight, changing the overall impression of the nose to look much more refined and defined.

• The implant sculpted to match the nasal bone contours blends naturally, completing an aesthetically pleasing dorsal line without an artificial appearance.

Profile view changes

• With appropriate elevation of the nasal tip and a smooth transition along the bridge line, the profile silhouette was significantly improved.

• Correcting the nasolabial angle refined the infratip and lower nasal line, making the overall profile view more balanced.

Overall change in impression

• Along with a natural nasal line, correcting the nasolabial angle reduced the appearance of a protruding mouth and improved overall facial balance.

• The natural yet distinct nasal line desired by the patient was successfully achieved.

The core of this surgery was a customized approach tailored to the patient's nasal anatomy. When placing an implant after hump reduction, it is essential to carve it precisely according to the height and width of the nasal bone. Creating an implant that conforms to the shape of the nasal bone allows for a natural and stable result.

Combining the establishment of tip support through septal reconstruction with autologous rib cartilage tip plasty was planned not merely to raise the tip height, but to elevate the structural stability of the entire nose. Nasolabial angle correction served as the finishing touch of the nasal profile, contributing significantly to balancing the entire face rather than changing the nose alone.

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

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