Bulbous Nose and Retracted Columella Correction with Closed Rhinoplasty

noselab
2024년 8월 9일
3분 분량

최종 수정일: 9월 30일

Hello, this is Dr. Chayoung Kang, Director of Noselab Rhinoplasty Clinic. Today, I will introduce a case of bulbous nose and retracted columella correction performed through the closed rhinoplasty approach.

The patient had previously undergone nostril reduction surgery and presented with a bulbous, blunt, and droopy nose tip as well as a retracted columella. Her goal was to achieve a natural yet sophisticated nasal appearance.

Preoperative Analysis of Bulbous Nose and Retracted Columella

Preoperative frontal view before bulbous nose and retracted columella correction with closed rhinoplasty in Korea — Frontal view

Blunt and wide nose tip
Small and asymmetric nostrils.
Wide nose.

Side profile

Droopy nose tip
Retracted columella that makes the alar more prominent.
Long philtrum and protruding mouth.

Preoperative 45-degree view showing wide bulbous nose and blunt droopy tip before retracted columella correction — 45-degree angle

Prominent width of the nose.
Droopy and blunt nose tip.

Preoperative nostril view showing asymmetry and small nostrils before bulbous nose and retracted columella correction — Nostrils photo

The nostrils had become small due to the previous nostril reduction surgery.
Noticeable nostril asymmetry.

Surgical Techniques for Bulbous Nose and Retracted Columella Correction

a) Autologous costal cartilage harvesting:

From the 8th rib of the patient’s right side. The incision was around 2.5 cm and we harvested 4 cm approx. of the rib cartilage to perform a septal graft extension surgery in order to lower the columella and correct the nasolabial angle.

b) Septal graft extension surgery:

Reinforcement and extension of the septal cartilage by using the autololgous costal cartilage.
Droopiness correction and heightening the nose tip structure.

c) Bulbous nose correction:

Partial removal of the nose tip subcutaneous tissue. Alar cartilage relocation and tying.
Matching the balance between the contour of the nose tip and the general height increase naturally.

d) Descent and correction of the columella:

Lowering and reinforcing the retracted columella by using the self-rib cartilage, and improving the balance with the alar cartilage.
Achieving an effect to make the philtrum look shorter.

e) Nasolabial angle correction:

Correction of the nasolabial angle using the autologous cartilage to improve the appearance of the protruding mouth.

f) Increasing the height of the bridge and adjusting the starting point.

Removal of the foreign substance (hyaluron filler), and insertion of an implant to lower the starting point.

Every procedure was performed through the closed rhinoplasty approach, without leaving any external scars.

Before and after surgery photos

Frontal view before surgery (left), After surgery (right)

The blunt and wide nose shape was corrected to look more delicate naturally.
The width of the nose was reduce, and looks overall slimmer.
Improved nostril asymmetry and their visibility remained natural.

Side profile before surgery (left), After surgery (right)

Balance improvement as the droopy nose tip was raised.
Harmony improvement between the previously retracted columella and the alar, as the columella was lowered.
Correction of the long philtrum, short starting point and protruding mouth.

45-degree angle before surgery (left), After surgery (right)

The wide nose contour became slimmer.
Enhacement of the three-dimensionality of the nose tip.
Natural-looking straight line nose shaping.

Nostrils before surgery (left), After surgery (right)

Improvement of the nostrils’ condition while maintaining their size, result from the previous nostril reduction surgery.
The appearance improved as the asymmetry improved.

After surgery table photos

Photos taken immediately after surgery, frontal view, side profile and 45-angle view.

Overview – Retracted columella lowering and bulbous nose rhinoplasty

This case is a complex rhinoplasty case that successfully met the patient’s needs despite the limitations created by the previous rhinoplasty. The overall balance of the nose was improved by lowering the columella, and we were able to achieve harmonious results by simultaneously correcting the nose tip, raising the bridge, and reducing the width of the nose.

In particular, the most difficult part was maintaining the size of the nostrils that had been reduced due to previous rhinoplasty while improving the overall shape of the nose. This was the result of making the most of the advantages of the closed approach and applying intricate surgical techniques.

We successfully constructed the image of the natural, yet sophisticated nose that the patient wanted, and the overall facial balance was improved along with the effect of making the mid-face appear shorter.

I hope this case will provide hope to those who are concerned about a retracted columella, a bulbous nose, or a blunt and droopy nose. Even if you have had previous surgery or have complex problems, you can still achieve satisfactory results with proper surgical planning and techniques.

Noselab Rhinoplasty Clinic always provides the most optimized surgical plan for each patient based on the latest medical technology and abundant experience. Those who are considering rhinoplasty should consult with a specialist to find the method that is best for them.

With Noselab Clinic you can achieve a beautiful and healthy nose!

Thank you,

Noselab Rhinoplasty Clinic

Dr. Chayoung Kang.