Bulbous Nose Correction Rhinoplasty with Dragon Nose Refinement
- Dr. Chayoung Kang
- 2024년 10월 29일
- 6분 분량
This case reviews bulbous nose correction rhinoplasty in a patient with a wide and rounded nasal tip, dragon-like lower nasal contour, columella retraction, low nasion, mild bridge deviation, protrusive lip profile, nostril asymmetry, and a history of multiple nasal filler injections. Surgery focused on filler removal, septal extension grafting, alar cartilage repositioning, alar cartilage suturing, cautious subcutaneous tissue reduction, donor rib cartilage support, silicone implant placement for dorsal line correction, columella retraction correction, nasolabial angle adjustment, and closed rhinoplasty structural refinement.
Author: Dr. Cha-Young Kang
Clinic: NoseLab Clinic
Published: 2024
Last Updated: 2026
Introduction
Hello, this is Dr. Cha-Young Kang of NoseLab Clinic.
This case involves bulbous nose correction rhinoplasty in a patient who wanted to improve a wide and rounded nasal tip, dragon-like lower nasal contour, and retracted columella.
The patient also had a low nasion, mild bridge deviation, protrusive lip profile, and nostril asymmetry. Because the patient had a history of repeated nasal filler injections, residual filler also needed to be considered during surgical planning.
The goal was not to make the nose overly thin or sharp. Instead, the plan focused on creating a more balanced nasal tip, improving lower nasal support, adjusting the columella position, refining the bridge line, and improving nostril balance within the patient’s anatomical limits.
The surgery was performed using a closed rhinoplasty / endonasal approach.
Surgical History Before Bulbous Nose Correction Rhinoplasty
The patient had a history of filler treatment and facial surgery before visiting NoseLab Clinic.
3 years ago: Multiple nasal filler injections, including 1-year and 5-year filler products
8 months ago: Philtrum reduction surgery
Because filler may remain in the nasal soft tissue and affect contour planning, filler history was reviewed before surgery.
Patient Goals for Bulbous Nose Correction Rhinoplasty
The patient’s main concerns were a bulbous nasal tip, dragon-like nose contour, and columella retraction.
The patient wanted to improve:
Wide and rounded nasal tip
Dragon-like lower nasal contour
Retracted columella
Low nasion and bridge balance
Nostril asymmetry
Overall nasal balance without an overly sharp appearance
Because the patient had a protrusive lip profile and previous philtrum reduction surgery, nasal tip projection, columella position, and nasolabial angle were evaluated together.
Preoperative Analysis Before Bulbous Nose Correction Rhinoplasty
Preoperative design consultation photos were reviewed from the frontal, side, oblique, and nostril views.
Frontal View: Bulbous Tip and Mild Bridge Deviation
From the frontal view, the nasal tip appeared bulbous and wide.
A dragon-like lower nasal contour was visible, and the nasion appeared low.
The nasal bridge showed mild deviation, which affected the overall frontal balance.
Side View: Low Nasion and Columella Retraction
From the side profile, the nasion appeared low, and the columella was retracted.
The protrusive lip profile made the relationship between the nasal tip, columella, and upper lip especially important.
For this reason, the nasolabial angle and columella position were included in the surgical plan.
Oblique View: Dragon Nose Contour and Tip Shape
From the oblique view, the rounded tip and dragon-like contour were evaluated together.
The lower nasal line required refinement without making the tip excessively thin or artificial-looking.
Nostril View: Nostril Asymmetry
From the nostril view, nostril asymmetry was observed.
Nostril shape can be affected by septal support, alar cartilage position, columella position, scar tissue, and healing response.
Therefore, nostril balance was planned together with tip support and lower nasal framework adjustment.
Surgical Plan for Bulbous Nose Correction Rhinoplasty
The surgical plan included bulbous tip refinement, dragon nose contour correction, columella retraction correction, filler removal, bridge line correction, and nostril balance improvement.
Bulbous Tip Correction with Septal Extension Support
A septal extension graft was planned to support and define the nasal tip.
This provided a stable framework for tip projection and lower nasal control.
The goal was to refine the wide nasal tip while avoiding an overly sharp or pinched appearance.
Cautious Subcutaneous Tissue Reduction
Excess subcutaneous tissue was reduced carefully where appropriate.
In bulbous nose correction, excessive tissue removal can increase the risk of skin problems, contour irregularity, scarring, or compromised blood supply.
For this reason, tissue reduction was performed conservatively and selectively.
Alar Cartilage Repositioning and Suturing
The alar cartilage was repositioned and sutured to refine the nasal tip.
This helped improve tip shape while preserving a natural-looking contour.
Dragon Nose Refinement with Lower Nasal Support
The dragon-like lower nasal contour was addressed through alar cartilage repositioning and structural support.
Septal cartilage was added to the alar structure to help lower the nostril area and improve harmony between the columella, alar rims, and nasal tip.
Tip Elevation and Bridge Line Correction
Tip projection and height were controlled using septal cartilage and donor rib cartilage for structural support.
Residual filler was removed during surgery.
A silicone implant was inserted to create a straighter and more balanced bridge line, based on the patient’s nasal structure and skin condition.
Columella Retraction Correction and Nasolabial Angle Adjustment
The retracted columella was adjusted to improve the relationship between the nasal tip, columella, and upper lip.
This helped improve the nasolabial angle and overall side profile balance.
Surgical Results After Bulbous Nose Correction Rhinoplasty
Frontal View: Bulbous Tip and Nasal Balance
From the frontal view, the bulbous and wide nasal tip appeared more refined after cartilage repositioning, suturing, and tip support.
The deviated impression appeared reduced, and the overall nasal balance appeared improved.
Side View: Columella and Nasolabial Angle
From the side profile, the columella appeared better positioned after columella retraction correction.
The nasolabial angle appeared more balanced, and the relationship between the nasal tip and upper lip appeared improved.
Oblique View: Dragon Nose Contour
From the oblique view, the dragon-like contour appeared softer after lower nasal support and cartilage repositioning.
The nasal tip appeared more structured while maintaining a natural-looking contour.
Bridge Proportion and Nasion Height
The nasion and bridge line appeared better balanced after filler removal and dorsal line correction.
The raised bridge proportion helped improve overall facial balance without creating an overly high or artificial-looking profile.
Nostril View: Nostril Balance
From the nostril view, nostril asymmetry appeared improved after lower nasal framework adjustment and columella correction.
Because nostril shape can change during healing, the final nostril balance should be evaluated over time.
Key Surgical Considerations in Bulbous Nose Correction Rhinoplasty
The goal of bulbous nose correction is not always to make the nose very thin.
In many patients, the more appropriate goal is to create better balance, definition, and support while maintaining a natural-looking nasal tip.
Tip projection and tip height are important because they affect how three-dimensional the nasal tip appears from the frontal, side, and oblique views.
Alar cartilage repositioning and suturing can help refine the tip shape, but excessive narrowing may create an unnatural or pinched appearance.
Subcutaneous tissue reduction must also be approached carefully. Over-removal of soft tissue may increase the risk of scarring, contour irregularity, skin compromise, or necrosis.
For this reason, bulbous nose correction rhinoplasty requires individualized planning based on skin thickness, cartilage strength, nasal tip width, alar cartilage shape, filler history, and healing response.
Surgeon’s Commentary
Correcting a bulbous nose and dragon-like lower nasal contour requires more than simply reducing nasal tip volume.
In this case, the surgical plan required evaluation of the nasal tip, columella, nostrils, nasion height, bridge deviation, filler history, and the patient’s protrusive lip profile.
Because the patient also had columella retraction, the lower nasal structure needed to be rebuilt in a way that improved the nasolabial angle and supported the nostril area.
Filler removal, septal extension grafting, donor rib cartilage support, alar cartilage repositioning, and cautious soft tissue adjustment were combined to refine the tip and lower nasal contour.
This case shows that bulbous nose correction and dragon nose refinement should be planned according to each patient’s anatomy, previous treatment history, skin condition, and desired degree of change.
FAQ
What is bulbous nose correction rhinoplasty?
Bulbous nose correction rhinoplasty is a surgery that refines a wide or rounded nasal tip by adjusting cartilage support, soft tissue thickness, tip projection, and nasal tip shape.
What is dragon nose correction?
Dragon nose correction refers to improving a lower nasal contour that appears heavy, rounded, or downward-curved in a way that affects nasal balance. Correction may involve alar cartilage repositioning, septal support, and columella adjustment.
Can bulbous nose correction be done after nasal filler?
Bulbous nose correction may be performed after nasal filler, but residual filler should be evaluated and removed when needed because it can affect contour, swelling, and surgical planning.
Why is columella retraction important?
Columella retraction can affect the nasolabial angle, nostril exposure, side profile, and lower nasal balance. Correcting it may help improve the relationship between the nasal tip and upper lip.
Can nostril asymmetry improve during bulbous nose correction?
Nostril asymmetry may improve when septal support, columella position, alar cartilage balance, and lower nasal framework are adjusted. The degree of improvement varies depending on anatomy and healing response.
International Consultation
For international patients, a photo-based consultation may help clarify whether bulbous nose correction rhinoplasty, dragon nose refinement, columella retraction correction, filler removal, septal extension grafting, nostril asymmetry correction, or closed rhinoplasty may be needed.
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