Correction of a Bulbous and Upturned Nose_Rhinoplasty Korea

Hello, this is Dr. Cha-Young Kang, Director of Nose Lab Clinic.

Today, I’d like to introduce a rhinoplasty case for a patient who was concerned about having a bulbous and upturned nose.

This patient expressed a desire for a more natural nasal shape, and we conducted a customized surgery that balanced the patient's aesthetic preferences with safety considerations..

1. Pre-Surgery Design Consultation

Patient's Requests:

• defined and slightly elevated nasal tip.

• straight nasal profile (creating a "straight nose" appearance).

• rounded, but not overly pointed, nasal tip.

• Natural results without the obvious appearance of surgery.

• Preferably using rib cartilage, if possible.

Now, let’s take a detailed look at the patient’s pre-operative condition:

Pre-Surgery Design Photos: Front, Left Oblique, and Side Views

Front View:

• The nostrils are highly visible, giving the nose an upturned appearance.

• The nasal tip appears bulbous and elevated.

• The nasal root (between the eyebrows) is low, creating a flat and less defined profile.

Side View:

• The nasal tip is upturned, making the nose appear short.

• The nose looks shorter than average.

• The nasal root is noticeably low, further contributing to the overall lack of definition.

Oblique View:

• The nose appears short from this angle as well.

• A slight dorsal hump is visible along the nasal bridge.

Pre-Surgery Design Consultation: Right Side, Oblique, and Nasal Base Photos

Nasal Base:

• Slight asymmetry in the nostrils is visible.

• The nasal tip appears broad and lacks definition.

2. Surgical Plan

Considering the patient's condition and specific requests, the following surgical plan was established:

a) Use of Septal Cartilage (with the possibility of adding ear cartilage if necessary):

b) Smoothing the Nasal Dorsum:

c) Dorsal Augmentation with Silicone Implant:

d) Refinement of Nasal Shape within Safe Limits:

Since the patient preferred not to use rib cartilage, we decided to use septal cartilage as the primary material. However, I explained that the size, shape, and thickness of septal cartilage vary from person to person, and it is difficult to assess its exact condition before surgery. Additionally, I informed the patient that septal cartilage is less durable in maintaining shape compared to rib cartilage, which limits its ability to create a very high nose. There is also a possibility of tip deformity over time.

Taking these limitations into account, I recommended the safest and most natural design before proceeding with the surgery.

3. Surgical Procedure

The surgery was performed using a closed (endonasal) approach, with the following steps:

a) Septal Cartilage Harvesting:

• Since the septal cartilage was not large, I harvested a portion that included some bone from the posterior area to ensure stability.

• septal extension graft was performed to support the structure.

b) Nasal Tip Correction:

• The septal cartilage was used to lower the upturned nasal tip for a more natural appearance.

• Since the septal cartilage was not strong enough to significantly raise the nasal tip, ear cartilage was not used.

c) Dorsal Hump Correction:

• The irregularities along the nasal bridge were smoothed out.

•  silicone implant was used to improve the dorsal line and create a more refined profile.

d) Nostril and Overall Nasal Shape Improvement:

• The bulbous nasal tip was refined for a slimmer appearance.

• symmetry of the nostrils was corrected.

• slight hump was reduced to create a smoother contour.

All of these steps were performed using the closed approach, allowing the surgery to be completed without any external scarring.

4. Before and After Comparison

The post-surgery photos reveal the following improvements:

Frontal view before surgery (left) after surgery (right)

• The previously upturned nasal tip has been naturally lowered, reducing the visibility of the nostrils.

• The once bulbous nose has been refined, giving a more sophisticated and elegant appearance.

• The previously low area between the eyebrows has been enhanced, adding overall definition and balance to the face.

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

• The previously upturned nasal tip has been appropriately lowered, improving overall facial balance.

• The nose, which appeared short, has been corrected to achieve a more natural proportion.

• A smooth, continuous line has been created from the glabella (area between the eyebrows) to the nasal tip, enhancing the overall nasal profile.

45-degree angle view before surgery (left) after surgery (right)

• The nose, which previously appeared short, now has an improved length for a more balanced look.

• The subtle hump on the nose has been smoothly corrected.

• Overall, a natural and straight dorsal line has been achieved, enhancing the nose’s aesthetics.

Nostrils before surgery (left) after surgery (right)

Great improvement of the nostril asymmetry.

Natural-looking correction of the skin remaining from the previous nostril lowering surgery.

5. Post-Surgery Photo Collection

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

Photo of the nostrils

6. Summary

This case serves as an excellent example of personalized rhinoplasty, where both the patient's preferences and safety were prioritized. The patient did not wish to use rib cartilage, so the surgery was carefully planned to maximize results using only septal cartilage.

Particular attention was given to avoiding any overly ambitious designs, keeping the limitations of septal cartilage in mind. The goal was to achieve a safe, natural outcome. As a result, the upturned nasal tip was lowered smoothly, the bulbous appearance of the nose was refined, and a well-balanced nasal shape was achieved.

Key highlights from this surgery include:

1. Respect for the Patient’s Preferences: The patient's request to avoid rib cartilage was honored.

2. Focus on Safety: Aware of the limitations of septal cartilage, we avoided excessive designs.

3. Natural-Looking Results: The outcome was subtle and natural, without any obvious signs of surgery.

4. Comprehensive Problem Solving: Multiple concerns, such as an upturned tip, bulbous shape, and short nose, were addressed simultaneously for an improved overall result.

7. Closing Remarks

When it comes to rhinoplasty, especially for first-time patients, it is crucial to approach the procedure with caution and precision. To avoid the need for revision surgery, please keep the following points in mind:

1. Clearly communicate your desired design to the surgeon.

2. During consultation, ensure that the chosen design is realistic and achievable.

3. When selecting the materials necessary to achieve the design, be open to the surgeon’s recommendations.

4. Avoid overly ambitious designs.

At Nose Lab Clinic, we often encounter cases where the surgery itself was performed well, and the shape was aesthetically pleasing, but the patient chooses revision surgery due to personal dissatisfaction. In many of these cases, revision could have been avoided with thorough and clear consultation regarding the initial design.

For those considering rhinoplasty, I strongly advise taking the time to make a careful decision and engage in thorough consultations to find the most suitable surgical plan. At Nose Lab Clinic, we always prioritize patient safety and satisfaction, striving to provide personalized procedures tailored to each individual.

Through a comprehensive approach that simultaneously considers functional and cosmetic improvements, we aim to create beautiful noses that breathe easy.

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

Thank you.