Contracted Upturned Nose Revision with Autologous Rib Cartilage

Dr. Chayoung Kang
2024년 10월 17일
5분 분량

최종 수정일: 5월 14일

This case reviews contracted upturned nose revision in a patient with excessive nostril show, nasal tip contracture, nostril asymmetry, depressed scar tissue, and structural collapse after multiple previous rhinoplasty procedures. Reconstruction focused on septal rebuilding, dorsal contour restoration, alar cartilage support, and nostril correction using autologous rib cartilage.

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 contracted upturned nose revision in a patient with a long history of nasal surgery complications. The patient developed progressive nasal contracture, an upturned nasal tip, excessive nostril show, and nasal asymmetry after multiple previous surgeries and postoperative inflammation.

The surgery was performed using a closed rhinoplasty / endonasal approach with autologous rib cartilage. The goal was to rebuild the nasal framework, correct the upturned tip, improve nostril symmetry, and restore more stable nasal function.

Patient History – Contracted Nose After Multiple Rhinoplasty Surgeries

The patient presented with a contracted nose, excessive nostril exposure, and an upturned nasal tip caused by repeated surgeries and postoperative inflammation.

Previous Surgical History

The surgical history included:

2012: L-shaped silicone implant
2019: Silicone implant, autologous rib cartilage, alar base reduction, and philtrum reduction
2023: Silicone implant, ear cartilage graft, and alar lowering
2023: Postoperative inflammation after splint removal, treated with antibiotics
2023, five months later: Silicone implant removal
Six sessions of regenerative treatment before revision surgery

After repeated operations and inflammation, the nasal structure became shortened and unstable. The nasal tip rotated upward, nostril exposure increased, and the nasal bridge and tip lost clear structural definition.

Preoperative design consultation images: frontal, left oblique, and left profile views

Preoperative Analysis – Contracture and Structural Deformity

Preoperative examination showed that the main cause of deformity was structural collapse rather than simple soft tissue imbalance.

Key Findings

The main findings included:

Excessive nostril exposure
Nostril asymmetry
Blunt, upturned nasal tip
Depressed scar tissue at the nasal tip
Flat nasal bridge with poor definition
Inappropriate nasolabial angle
Reduced structural support after previous procedures

These findings confirmed that the case required structural reconstruction rather than minor contour adjustment or implant replacement.

Preoperative design consultation images: right oblique, right profile, and nostril views

Surgical Plan – Closed Rhinoplasty Korea with Autologous Rib Cartilage

This revision was planned using a closed rhinoplasty Korea approach to allow internal reconstruction without adding an external columellar incision. In a nose affected by repeated surgery and inflammation, preserving soft tissue integrity is important.

The surgical plan focused on rebuilding the septum, restoring nasal length, improving nostril balance, and creating stable dorsal and tip support.

Planned Procedures

The surgical plan included:

Septal extension using autologous rib cartilage
Total septal reconstruction for structural stability
Septal shift to correct nostril asymmetry
Controlled dorsal contour restoration using rib cartilage
Alar cartilage reconstruction
Nasolabial angle adjustment

Surgical Procedure and Reconstruction Strategy

The operation focused on restoring the nasal framework before refining the external contour. In contracted and upturned noses, the internal structure must be rebuilt first to prevent recurrent shortening or instability.

Rib Cartilage Harvesting

Autologous rib cartilage was harvested to provide sufficient material for structural reconstruction. This was necessary because the patient had significant support loss after repeated surgery and inflammation.

Septal Extension and Reconstruction

The septum was reconstructed to correct the contracted and upturned nasal tip. Septal extension helped restore nasal length and provide stronger tip support.

Nostril Asymmetry Correction

Septal shift and structural realignment were used to improve nostril balance. This helped reduce asymmetry caused by contracture and previous surgery.

Dorsal Contour Restoration

Rib cartilage was shaped to restore dorsal contour. The goal was to improve bridge definition while maintaining a natural profile line.

Alar Cartilage Reconstruction

Alar cartilage support was reconstructed to improve tip definition and nostril stability. This step helped reduce excessive nostril show and improve nasal base balance.

Nasolabial Angle Adjustment

The septum and nasal tip were repositioned to improve the nasolabial angle. This helped create a smoother relationship between the nose and upper lip.

Surgical Results – Structural Recovery and Nasal Balance

Frontal View

From the frontal view, nostril exposure was reduced, bridge definition improved, and the nasal tip alignment appeared more balanced.

Frontal before and after comparison of rhinoplasty. Pre-surgery view on the left, post-surgery view on the right, showing correction of nasal tip and nostril asymmetry. — Frontal view before surgery (left) after surgery (right)

Oblique View

The oblique view showed improved dorsal contour and reduction of the upturned tip appearance. Nostril show also appeared less prominent.

Oblique 45-degree before and after comparison of rhinoplasty. Pre-surgery view on the left, post-surgery view on the right, showing improved nasal bridge contour and refined nasal tip — 45-degree angle view before surgery (left) after surgery (right)

Side Profile View

From the side profile, tip projection improved, the dorsal contour became smoother, and the nasolabial angle was corrected to a more balanced position.

Side profile view before surgery (left) after surgery (right)

Nostril View

From the nostril view, the narrow nostril shape improved, the columella appeared more refined, and nostril symmetry was restored within the limits of the patient’s tissue condition.

ostril view before and after comparison of rhinoplasty. Pre-surgery view on the left, post-surgery view on the right, showing corrected nostril asymmetry and refined columella — Nostrils before surgery (left) after surgery (right)

Functional Outcome

Internal realignment and structural reconstruction helped improve nasal stability and airflow. Functional improvement was considered together with external shape correction.

Immediate Postoperative Evaluation

Immediate postoperative photos showed improved nasal projection, dorsal contour, nostril balance, and nasal tip position across frontal, oblique, side profile, and nostril views.

Because this was a complex revision case after multiple surgeries and inflammation, the result should be understood as structural recovery within the limits of scarred and previously operated tissue.

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

Educational Perspective – Why Structural Reconstruction Matters

Contracted and upturned noses usually cannot be corrected through minor adjustments or implant exchange alone. The main issue is often structural shortening, scar contracture, and loss of support.

In this case, autologous rib cartilage reconstruction provided a stable framework for septal support, dorsal contour restoration, alar support, and nostril correction. A structure-first approach was necessary to reduce recurrent contracture and improve functional balance.

Surgeon’s Commentary

This was a complex revision rhinoplasty case involving contracted nasal tissue, an upturned tip, excessive nostril show, nostril asymmetry, depressed scar tissue, and multiple previous operations.

The key point was that the deformity was structural. When inflammation and repeated surgeries weaken the nasal framework, surface-level correction is not enough. The septum, nasal tip, alar cartilage, and dorsal contour must be rebuilt together.

Autologous rib cartilage was used because stronger support was needed for septal reconstruction, tip extension, and nasal base correction. The closed rhinoplasty / endonasal approach allowed internal reconstruction without adding an external columellar incision.

This case shows that contracted upturned nose revision should focus on structural reconstruction, nostril balance, and functional stability rather than simply increasing nasal height or changing the external contour.

FAQ

What causes a contracted and upturned nose after rhinoplasty?

A contracted and upturned nose can occur after postoperative inflammation, scarring, tissue damage, or loss of structural support. These changes may shorten the nose and increase nostril exposure.

Why is rib cartilage used in contracted upturned nose revision?

Rib cartilage is often used when septal or ear cartilage is insufficient. It provides stronger support for septal reconstruction, tip extension, and nasal framework rebuilding.

Can excessive nostril show improve after revision rhinoplasty?

Excessive nostril show can improve when the nasal tip is repositioned, septal support is rebuilt, and alar cartilage support is corrected. The degree of improvement depends on scar tissue and skin flexibility.

Why is structural reconstruction important in this type of case?

Structural reconstruction is important because the deformity is usually caused by support loss and scar contracture. Without rebuilding the framework, shape correction may not remain stable.