Hello, this is Dr. Cha-Young Kang, head surgeon at Nose Lab Clinic.
Today, I would like to share a successful case of revision rhinoplasty for a patient who struggled with a short, upturned nose. Despite having undergone multiple nasal surgeries in the past, the patient was unsatisfied with the outcomes. For the past two years, the patient's nose gradually became more upturned, and they also suffered from nasal obstruction.
In this case study, I’ll walk you through how we addressed these complex issues with a tailored surgical approach, showing how important personalized rhinoplasty can be.
Capsular Contracture:
Over time, fibrous tissue forms around silicone implants, which can contract and tighten.
This contraction exerts pressure on the implant, shortening the overall length of the nose and causing an upturned appearance.
Patient's Surgery History:
10 years ago: Silicone + ear cartilage graft
5 years ago: Silicone + ear cartilage + septal cartilage graft
6 months later: AlloDerm graft for cartilage visibility correction at the nasal tip
The patient started noticing their nose becoming progressively shorter over the past two years.
Patient's Key Concerns:
Correction of a short, upturned nose
Improvement of nasal obstruction
1. Design Consultation and Pre-Surgery Analysis
Pre-Surgery Design Consultation Photos
Frontal View:
Overly exposed nostrils
Nose appears small and thin
Side View:
Nose tip is both upturned and drooping
The nasal starting point (radix) is high
The nasal tip appears bulbous
Oblique View:
Nose appears short overall
Pre-Surgery Design Consultation Photos
Nostril View:
Slight nostril asymmetry
Columella tilts slightly to the right
2. Surgical Plan
Based on the patient’s condition and concerns, we created a customized surgical plan:
a) Reuse of previous cartilage:
The septal cartilage and ear cartilage from previous surgeries were reused where possible.
b) Donor rib cartilage graft:
The primary material for the surgery was donor rib cartilage, which was used to perform a septal extension graft to correct both the short and upturned nose.
c) Replacement of nasal implant:
The old implant was removed.
A new silicone implant was placed at a lower starting point to create a natural nasal bridge.
d) Additional procedures to improve nasal obstruction:
Septoplasty to straighten the nasal septum
Turbinate reduction with radiofrequency laser to treat enlarged turbinates
Nasal Endoscopy Photos 1.Right Side 2.Left Side
This surgical plan was based on the results of the patient’s pre-surgery nasal obstruction tests. The tests revealed a deviated septum to the left and enlarged turbinates on both sides, leading to a diagnosis of septal deviation and hypertrophic rhinitis.
3. Surgical Details
Using a closed (endonasal) rhinoplasty approach, we performed the following procedures:
a) Donor Rib Cartilage Graft:
Donor rib cartilage was used alongside the patient’s existing septal cartilage for a septal extension graft. This corrected the upturned nose and lengthened the nose for a balanced appearance.
b) Reuse of Existing Cartilage:
Septal cartilage and ear cartilage from previous surgeries were carefully harvested and reused. The septal cartilage was combined with donor rib cartilage to perform the septal extension graft, while ear cartilage was reused to enhance the nasal tip, minimizing tissue loss.
c) Replacement of Nasal Implant:
The old implant was removed.
A new silicone implant was inserted at a lower starting point, creating a smoother and more natural nasal bridge.
d) Septoplasty:
The deviated septum was corrected, improving nasal airflow.
e) Turbinate Reduction:
Enlarged turbinates were reduced using radiofrequency laser, expanding the nasal airways and improving breathing.
f) Nasal Tip Angle Adjustment:
The angle between the nasal tip and the upper lip (nasolabial angle) was adjusted to improve the patient’s slightly protruding lips, giving a more harmonious profile.
g) Correction of Nostril and Columella Asymmetry:
Nostril asymmetry was improved, and the tilted columella was corrected.
All procedures were performed using a closed rhinoplasty approach, avoiding external scarring.
4. Before and After Comparison
Before (Left) / After (Right)
Frontal View:
The previously exposed nostrils are now less visible, and the nose appears more proportionate and balanced with the face.
Before (Left) / After (Right)
Side View:
The upturned, drooping nasal tip has been corrected, and the nasal starting point has been lowered, creating a longer, more balanced nose.
The bulbous nasal tip is now refined and natural-looking.
Nasolabial angle adjustments improved the appearance of protruding lips.
Before (Left) / After (Right)
Oblique View:
The nose, which previously appeared short, now has an elongated, proportional shape, enhancing the overall facial balance.
The nasal bridge to tip line is smooth and natural.
Before (Left) / After (Right)
Nostril View:
Nostril asymmetry has been improved.
The columella, which was previously tilted, is now straight and balanced.
5. Post-Surgery Photo Gallery
Photos taken immediately after surgery, frontal view, 45-angle view, and side profile.
Photo of the nostrils
6. Conclusion
This case exemplifies a successful personalized rhinoplasty for a patient who had previously undergone multiple surgeries. We were able to address multiple concerns—short nose, upturned tip, and nasal obstruction—while achieving a harmonious and natural outcome.
Key takeaways from this case:
Combined use of donor rib cartilage and existing cartilage: By combining the advantages of donor rib cartilage with the patient’s existing cartilage, we addressed the limitations of donor cartilage, such as potential absorption, and achieved a stable result.
Recycling previous cartilage: Reusing septal and ear cartilage minimized tissue loss and made the surgery more efficient.
Achieving both aesthetic and functional improvements: The surgery not only improved the appearance of the nose but also addressed functional issues such as nasal obstruction, providing the patient with both cosmetic and breathing benefits.
Closed rhinoplasty approach: The use of a closed approach allowed us to perform this complex surgery without external scars.
After surgery, the patient’s primary concerns—short nose, upturned tip, and nasal obstruction—were resolved, and the overall facial proportions and appearance became more balanced and refined.
7. Final Thoughts
For those struggling with a short or upturned nose, or concerns about using donor rib cartilage, I hope this case brings hope and insight. Revision rhinoplasty requires careful consideration of each patient’s unique situation and needs.
At Nose Lab Clinic, we take pride in our expertise and experience, offering personalized surgical plans that combine aesthetic and functional improvements. As an ENT specialist, I focus on enhancing both the appearance and functionality of the nose.
If you are considering rhinoplasty or revision surgery, I encourage you to consult with a specialist to find the best surgical approach for your unique needs.
We are committed to helping you achieve a beautiful and healthy nose.
This has been Dr. Cha-Young Kang, head surgeon at Nose Lab Clinic.
Thank you.
Comments