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Correction of Over-Rotated and Pinched Nose with Autologous Rib Cartilage Reconstruction_Rhinoplasty Korea

noselab

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


Today, I’d like to share a challenging case of reconstructive rhinoplasty to correct an over-rotated and pinched nose after multiple surgeries. This case highlights the importance of comprehensive structural restoration for long-term, natural results.

Before Surgery: Frontal, Right Side, and Oblique Side View Photos


1. Patient Background and Desired Outcomes


Surgical History:

  • 1991: Initial rhinoplasty with silicone

  • 2020: Augmentation with silicone and donated rib cartilage

  • 2021: Revision for height adjustment

  • 2022: Philtrum reduction surgery


Patient’s Requests:

  • Correction of over-rotated, pinched nose

  • Desire for a natural but refined straight nasal line


2. Preoperative Analysis

Before Surgery: Nostril View, Left Side View, and Oblique Side View Photos


Frontal View:

  • Noticeable nasal rotation (upturned tip)

  • Pinched appearance of the alar (nostril) region

  • Crooked nasal bridge

  • Asymmetry in the nostrils

Profile View:

  • Drooping nasal tip

  • Hump on the bridge

  • Nose appears short

Nasal Base View:

  • Asymmetrical nostrils

  • Deviated columella towards the left

  • Pinched appearance of the alar cartilage


3. Surgical Plan


Reconstructive Goals:

  1. Crooked Nose Correction: Lateral osteotomy (sidewall realignment)

  2. Structural Reinforcement: Autologous rib cartilage graft for septal reconstruction

  3. Alar Cartilage Reconstruction: Repair the pinched nostril with dermal grafts

  4. Tip and Length Restoration: Septal extension graft for improved nasal length and tip projection

  5. Nostril Symmetry: Adjust alar base and lengthen nostrils with grafting

  6. Augmentation for Defined Line: Replace the existing silicone implant for enhanced height and a smooth straight line

  7. Nasolabial Angle Adjustment: Improve nasolabial angle to enhance facial balance

  8. Additional Facial Harmonization: Augment midface and refine facial lines with fat grafting to the forehead

Before (Left) / Immediately After (Right)

Before (Left) / Immediately After (Right)

Before (Left) / Immediately After (Right)

Before (Left) / Immediately After (Right)


4. Surgical Approach


Septal Reconstruction:

  • Used autologous rib cartilage to rebuild the damaged septum, providing a strong foundation for the nasal tip.

Alar Cartilage Reconstruction:

  • Repaired the significantly damaged alar cartilages on both sides and used dermal grafts to correct the pinched appearance.

Additional Procedures:

  • Midface augmentation (augmentation of nasolabial folds and correction of projection) for better facial balance.

  • Removal of foreign material in the forehead area with subsequent fat grafting for a smoother, natural contour.


5. Postoperative Results

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











Immediately After Surgery: Nostril View Photos


Frontal View:

  • The overly rotated, pinched areas appear natural and balanced.

  • Straightened nasal bridge, enhancing the symmetry and alignment.

  • Improved nostril symmetry.

Profile View:

  • Hump correction achieved a smooth, straight line.

  • Drooping nasal tip improved for a balanced, sophisticated profile.

  • Enhanced nasolabial angle creating a harmonious side view.

Nasal Base View:

  • Significant improvement in nostril symmetry.

  • Smooth, natural curvature of the alar rims without the previous pinched appearance.


6. Conclusion


This case successfully transformed a nose altered by multiple surgeries into a refined, natural, and structurally stable form. The critical focus was not merely on aesthetic improvement but on rebuilding the fundamental structure of the nose to ensure lasting results.


Corrective rhinoplasty, especially for complex cases, demands meticulous anatomical understanding and precise reconstruction. At Nose Lab, we prioritize both the beauty and the health of our patients. For those considering revision rhinoplasty, working with a highly experienced specialist is essential for the best results.


Thank you for reading. This is Dr. Cha-Young Kang from Nose Lab Clinic.



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