Correction of an 18-Year-Old Upturned Nose and Columella Retraction

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

Today, I’m sharing the case of a patient who struggled with an upturned nose for nearly two decades and achieved remarkable improvement through autologous rib cartilage reconstruction.

Design Consultation: Frontal View, Left Side View, and Oblique Side View Photos

📍 Surgical History

18 years ago: AlloDerm + silicone implant + ear cartilage graft (suspected AlloDerm infection; upturned nose developed)
17 years ago: Septal cartilage + ear cartilage + silicone implant revision (upturned nose persisted after 6 months)
6 months later: Silicone implant removal
3 months later: Silicone implant + cartilage revision surgery

🔎 Initial Evaluation

Design Consultation: Nostril View, Right Side View, and Oblique Side View Photos

1. Frontal View

Upturned nasal tip
Nostril asymmetry
Deviated nasal bridge

2. Side View

Short, upturned nose
High nasion starting point
Retracted columella
Long-appearing philtrum
Protruding upper lip

3. Oblique View

Short, upturned nose
Long philtrum appearance
Protruding upper lip

4. Nostril View

Nostril asymmetry
Deviated columella (leftward)
Scar tissue in the upper left columella

Nasal Endoscopy Photos

ℹ️ Special Considerations

Known allergy to cephalosporins
Worsened rhinitis symptoms after previous surgeries
Initially suspected contracted nose

✨ Patient's Goals

Correct the upturned nose (reduce nostril show)
Achieve a natural, balanced result

💉 Surgical Plan and Execution

1. Status Evaluation

Found that over two-thirds of the lateral crus (alar cartilage) on both sides had been removed during prior surgeries
Severe columella retraction and a shallow nasolabial angle
Presence of scar tissue on the left side of the columella

2. Structural Reconstruction

Reconstruction of the alar cartilages using autologous rib cartilage
Septal extension graft to support and reposition the nasal tip downward
Columella lengthening

3. Aesthetic Refinement

Correction of the nasolabial angle to improve the protruding upper lip appearance
Lowering the high starting point of the nasal bridge
Nostril asymmetry correction

✅ Postoperative Outcome

Before (Left) / Immediately After (Right)

1. Frontal View

Reduced nostril exposure
Improved nostril symmetry
Straighter nasal bridge
Successful correction of the upturned nose

Before (Left) / Immediately After (Right)

2. Side View

More natural starting point of the nasal bridge
Improved columella projection
Corrected nasolabial angle
Shortened appearance of the philtrum
Improvement in the protruding upper lip profile

Before (Left) / Immediately After (Right)

3. Nostril View

Balanced nostril shapes
Straighter columella
Diminished appearance of scar tissue

Before (Left) / Immediately After (Right)

👨‍⚕️ Surgeon’s Insight

Immediately After Surgery: Frontal, Side, and Oblique Side View Photos

Immediately After Surgery: Nostril View Photos

This case highlights the challenge of correcting a long-standing upturned nose following multiple prior surgeries over 18 years. Intraoperative findings revealed that more than two-thirds of the original alar cartilages had been removed, severely compromising nasal support and causing the tip rotation and retraction.

Although the patient initially suspected a contracted nose, it was actually structural collapse due to cartilage loss. Using autologous rib cartilage, we reconstructed the lateral crus and performed septal extension grafting to correct the upturned tip and columella retraction.

We also improved the nasolabial angle and addressed the protruding lip appearance for a more balanced facial profile.

Special care was taken with postoperative antibiotics due to the patient’s cephalosporin allergy, and the worsened rhinitis symptoms were considered during surgery planning.

Thanks to these comprehensive measures, both aesthetic and functional results were successfully achieved.

Thank you for reading.

This has been Dr. Cha-Young Kang, Director of NOSELAB Clinic.