Hello, this is Dr. Cha-Young Kang, head surgeon at Nose Lab Clinic.
Today, I’d like to share a rhinoplasty revision case involving a patient with complex nasal issues. This patient had multiple concerns, including a contracted nose, bulbous nasal tip, upturned nose, short nose, and nostril asymmetry. Additionally, the patient had undergone several previous surgeries, making this a challenging revision case.
1. Patient’s Surgical History
2019: Tipplasty using ear cartilage, philtrum reduction
Early 2022: Dorsal and tip surgery using autologous rib cartilage
Mid 2022: Inflammation occurred 10 days after surgery, resulting in implant removal
Late 2022: Tip surgery using autologous rib cartilage, paranasal augmentation
The patient also underwent 3 sessions of stem cell injections at our clinic to promote tissue healing.
2. Patient's Requests
Correction of the upturned nose
Reduction of visible nostrils
Decrease in the nasolabial angle (angle between the nose and upper lip)
Correction of the Alar Columellar Relationship (ACR)
Correction of nostril asymmetry
3. Design Consultation
We conducted a detailed analysis of the patient's condition prior to surgery:
Pre-Surgery Design Consultation: Frontal, Left Oblique, and Left Profile Views
Frontal View:
The nasal tip appeared excessively upturned.
There was a significant amount of visible nostrils.
The nasal tip looked bulbous and wide.
Noticeable nostril asymmetry was present.
Oblique View:
The nose appeared short.
The nasal tip was noticeably upturned.
The nostrils were overly visible.
Profile View:
The nasal tip was highly upturned.
The columella (the tissue between the nostrils) was too prominent, hanging downward.
The nasolabial angle was too large, contributing to the upturned appearance.
Pre-Surgery Design Consultation: Right Oblique, Right Profile, and Nostril Views
Nostril View:
There was significant nostril asymmetry.
4. Surgical Plan and Procedure
Considering the patient's condition and requests, we developed the following surgical plan. The surgery was performed using a closed (endonasal) approach, which allowed us to achieve the desired results without external scarring:
a) Harvesting and Grafting of Autologous Rib Cartilage:
Rib cartilage was harvested from the patient to ensure a sufficient amount for nasal reconstruction.
A septal extension graft was performed to correct the upturned nose and provide structural stability.
b) Nostril Lowering Surgery:
The nostrils were lowered to reduce the amount of visible nostrils and improve asymmetry.
Autologous rib cartilage was used to augment the alar cartilage, correcting nostril asymmetry.
c) Dorsal Augmentation with Silicone Implant:
A silicone implant was inserted to create a smooth, natural dorsal line.
The implant was shaped and placed to match the patient's facial structure, ensuring harmony and natural results.
d) Correction of Nasal Tip and Columella:
The nasal tip was lowered to address the upturned appearance.
The columella was adjusted to restore balance to the nose, and the nasolabial angle was reduced for a more natural appearance. e) Refinement of Nasal Tip Contour: The bulbous and wide nasal tip was refined to create a more slender, sophisticated shape (bulbous nose correction). f) Correction of Nostril Asymmetry: The septal extension graft, combined with alar cartilage repositioning and cartilage suturing, improved the symmetry of the nostrils.
All procedures were performed through a closed approach, ensuring no external scarring.
5. Before and After Photo Comparison
Upon reviewing the immediate post-surgery photos, the following improvements can be observed:
Frontal view before surgery (left) after surgery (right)
Frontal View:
The upturned nasal tip has been naturally lowered, significantly reducing visible nostrils.
The previously bulbous and wide nasal tip has been refined into a sleek and sophisticated shape.
Nostril asymmetry has been noticeably improved, creating a more balanced appearance.
45-degree angle view before surgery (left) after surgery (right)
Oblique View:
The nose, which previously appeared short, now has a more appropriate length and height.
The upturned nasal tip has been naturally lowered, resulting in a smoother overall nasal contour.
The reduction in visible nostrils contributes to a more refined and balanced look.
Side profile view before surgery (left) after surgery (right)
Profile View:
The previously upturned nasal tip has been lowered, creating a natural curve.
The columella has been corrected, improving the balance between the nose and upper lip.
The nasolabial angle has been reduced, helping to soften the appearance of the protruding upper lip.
Nostrils before surgery (left) after surgery (right)
Nostril View:
Nostril asymmetry has been significantly corrected, with improved balance between the left and right sides.
The overall shape of the nostrils now appears more refined and natural.
6. Collection of Photos Immediately After Surgery
These are the frontal, side, and oblique side photos taken immediately after surgery.
These are nostril photos taken immediately after surgery.
7. Final Evaluation and Closing Remarks
This case is an excellent example of a successful revision rhinoplasty for a patient with multiple complex nasal issues. Given the patient’s history of multiple surgeries and prior complications with inflammation, meticulous surgical planning and advanced techniques were essential. This surgery focused on thoroughly removing contracted tissue and reconstructing the damaged cartilage to ensure long-term stability of the nasal tip, which is critical for maintaining satisfactory results.
For patients with significant nasal inflammation and an upturned tip, stem cell injection therapy can be very beneficial in softening the skin and improving its elasticity before surgery. In this case, stem cell treatments were used preoperatively, leading to an enhanced outcome by improving the skin condition, allowing for a smoother surgical process and better results.
This revision surgery addressed a range of issues, including a contracted nose, upturned tip, short nose, and nostril asymmetry. I hope this case provides hope for those facing similar concerns. Even with a history of multiple surgeries or complications like inflammation, excellent results can be achieved with the right surgical plan, techniques, and pre- and post-operative care.
At Nose Lab Clinic, we specialize in creating customized surgical plans tailored to each patient’s unique needs, leveraging our vast experience and expertise. Our comprehensive approach not only focuses on aesthetic improvements but also ensures functional enhancements, drawing on our deep anatomical knowledge as ENT specialists.
If you are considering rhinoplasty, especially revision surgery, I strongly recommend consulting with a highly experienced specialist. With the right guidance, you can find the most suitable surgical approach for your individual case. Nose Lab Clinic is here to support you every step of the way, working to achieve a beautiful and healthy nose.
This has been Dr. Cha-Young Kang, head surgeon at Nose Lab Clinic.
Thank you.
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