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:
Crooked Nose Correction: Lateral osteotomy (sidewall realignment)
Structural Reinforcement: Autologous rib cartilage graft for septal reconstruction
Alar Cartilage Reconstruction: Repair the pinched nostril with dermal grafts
Tip and Length Restoration: Septal extension graft for improved nasal length and tip projection
Nostril Symmetry: Adjust alar base and lengthen nostrils with grafting
Augmentation for Defined Line: Replace the existing silicone implant for enhanced height and a smooth straight line
Nasolabial Angle Adjustment: Improve nasolabial angle to enhance facial balance
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.


Comments