A Dramatic Transformation for Contracted and Upturned Nose – Revision Rhinoplasty in Korea

noselab
2024년 10월 17일
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This case study presents a complex revision rhinoplasty performed to correct a contracted nose and an upturned nasal tip caused by multiple prior surgeries and postoperative inflammation.

In this patient, structural collapse and asymmetry were resolved through septal reconstruction, dorsal contour restoration, and nostril correction using autologous rib cartilage, resulting in functional stability and natural nasal balance.

Author: Dr. Cha-Young Kang, Chief Director, NoseLab Clinic

Published: October 17, 2024

Hello, this is Dr. Cha-Young Kang, Chief Director of NoseLab Clinic.

This case involves a patient with a long history of nasal surgery complications who developed progressive nasal contracture and an upturned tip, requiring comprehensive structural reconstruction rather than surface-level correction.

Patient History – Contracted Nose After Multiple Rhinoplasty Surgeries

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

Surgical history

2012: L-shaped silicone implant
2019: Silicone implant, autologous rib cartilage, alar base reduction, philtrum reduction
2023: Silicone implant, ear cartilage graft, alar lowering
2023: Postoperative inflammation after splint removal, treated with antibiotics
2023 (5 months later): Silicone implant removal
Six sessions of stem cell therapy prior to revision surgery

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

Preoperative Analysis – Contracture and Structural Deformity

The preoperative examination confirmed that structural collapse rather than soft tissue imbalance was the primary cause of deformity.

Key findings

Excessive nostril exposure and asymmetry
Blunt, upturned nasal tip
Depressed scar tissue at the nasal tip
Flat nasal bridge with poor definition
Inappropriate nasolabial angle

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 full internal reconstruction while avoiding external scars.

Planned procedures

Septal extension using autologous rib cartilage
Total septal reconstruction for structural stability
Septal shift to correct nostril asymmetry
Creation of a controlled dorsal hump using rib cartilage
Alar cartilage reconstruction
Adjustment of the nasolabial angle

Surgical Procedure and Reconstruction Strategy

The operation focused on restoring the nasal framework before addressing contour.

Rib cartilage harvesting :

Sufficient rib cartilage was harvested to provide durable material for full reconstruction.

Septal extension and reconstruction :

The septum was rebuilt to correct the contracted, upturned tip and re-establish nasal length.

Nostril asymmetry correction :

Septal shift and structural realignment restored bilateral balance.

Dorsal contour creation :

Rib cartilage was sculpted to form a subtle, natural dorsal hump.

Alar cartilage reconstruction :

Reinforcement of alar structures improved tip support and definition.

Nasolabial angle adjustment :

Repositioning of the septum and tip softened the upper lip projection and improved profile harmony.

Surgical Results – Structural Recovery and Nasal Balance

Postoperative evaluation demonstrated clear improvement in nasal structure, symmetry, and proportion.

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)

Frontal View:

Reduced nostril exposure
Improved bridge definition
Balanced nasal tip alignment

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)

Oblique View:

Natural dorsal hump visible
Corrected upturned tip
Reduced nostril show

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

Profile View:

Improved tip projection
Smooth dorsal contour
Corrected nasolabial angle

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)

Nostril View:

Functional widening of narrow nostrils
Refined columella
Restored symmetry

Immediate Postoperative Evaluation

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

Immediate post-surgery nostril view after rhinoplasty, showing improved nostril symmetry and columella alignment with reduced exposure." — Photo of the nostrils

Educational Perspective – Why Structural Reconstruction Matters

Contracted and upturned noses cannot be corrected through minor adjustments or implant replacement alone.

In this case, rib cartilage reconstruction provided a stable framework capable of resisting recurrent contracture, while internal realignment restored both nasal length and airflow. A structure-first approach was essential to achieve lasting correction.

Final Thoughts

This case demonstrates that revision rhinoplasty for contracted and upturned noses requires comprehensive structural rebuilding rather than cosmetic reshaping alone.

Through septal reconstruction, dorsal contour restoration, and nostril realignment using autologous rib cartilage, long-term stability and functional balance were achieved in a patient with a complex surgical history.

FAQ

Q1. What causes nasal contracture after rhinoplasty?

Nasal contracture typically results from postoperative inflammation, scarring, or tissue damage that leads to shrinkage and distortion of nasal structures.

Q2. Why is rib cartilage used in revision rhinoplasty?

Rib cartilage provides strong, durable support when septal or ear cartilage is insufficient, especially in cases with severe structural loss.

Q3. Can an upturned nose be corrected after multiple surgeries?

Yes. Correction is possible through septal extension and structural reconstruction, though it requires careful planning and robust cartilage support.

Q4. Why is a closed approach preferred in complex revision cases?

A closed approach allows internal reconstruction without additional external scarring, preserving soft tissue integrity in already compromised noses.

🎥 This patient’s real story is available on our YouTube channel (2 parts):