Revision Rhinoplasty Korea – Starting Point Lowering and Tip Reconstruction

Hello, this is Dr. Chayoung Kang, Director of Noselab Clinic.

This case highlights a complex revision rhinoplasty Korea, performed for a patient with an excessively high nasal bridge starting point, a disproportionately high bridge, and a flat nasal tip that lacked three-dimensional definition. The surgical goal was to lower the starting point and refine the nasal tip for a more sophisticated, balanced appearance.

Preoperative Assessment and Key Findings

The patient had previously undergone two rhinoplasty procedures and a nostril reduction, resulting in multiple structural limitations. During the preoperative consultation, several issues were identified.

Frontal View Findings

• Abnormally high nasal bridge starting point

• Visible deviation toward the right

• Nostril asymmetry

• A dent along the upper right alar area

Lateral View Findings

• High nasal bridge but droopy, under-projected tip

• General lack of volume

• Protruding mouth

• Retracted columella

• Wide nasolabial angle

Oblique View Findings

• Unnaturally high starting point

• Flat and droopy nasal tip

Nostril View Findings

• Asymmetry from previous nostril reduction

• Confirmed left-side nasal constriction

Surgical Plan for Revision Rhinoplasty Korea

A tailored plan was created based on functional needs, structural limitations, and aesthetic goals.

Core Surgical Components

• a) Reconstruction of the nasal tip and septal extension graft using autologous rib cartilage

• b) Correction of septal deviation and left-side constriction

• c) Lowering of the nasal bridge starting point with replacement implant

• d) Creating a smooth and natural bridge curve

• e) Reconstruction of the right alar cartilage

• f) Additional grafting to reinforce depressed areas

Although the patient requested a sophisticated and high nose, we carefully planned a result that respects skin elasticity and the limitations created by previous nostril reduction.

Intraoperative Findings and Surgical Execution

During surgery, the internal condition was more severe than expected.

Key Intraoperative Procedures

• a) Removal of severe adhesions between cartilage and skin

• b) Strong reinforcement of the weakened septum using rib cartilage

• c) Elevation and reconstruction of the nasal tip

• d) Lowering and reshaping of the nasal bridge, including implant exchange

• e) Complete reconstruction of the nearly absent right alar cartilage

• f) Correction of the depressed upper alar region

• g) High-frequency laser reduction of inferior turbinate mucosa for hypertrophic rhinitis

All procedures were performed through a closed (endonasal) rhinoplasty approach.

Before & After Results

Before surgery (left), After surgery (right)

Frontal Comparison

• Starting point lowered to a natural level

• Deviation corrected

• Improved nostril balance (with limitations due to prior alarplasty)

• Sharper, more defined nasal contour

Before surgery (left), After surgery (right)

Side View Comparison

• Droopy tip improved through proper elevation

• Enhanced balance between bridge and tip

• Curved bridge created a more refined appearance

Before surgery (left), After surgery (right)

Oblique Comparison

• Bridge deviation corrected

• Droopy midline improved

• Overall smoother and more stable profile

Before surgery (left), After surgery (right)

Nostril View Comparison

• Left airway widened → congestion improved

• Right alar condition enhanced after reconstruction

• Perfect symmetry not possible due to prior surgery, but overall balance achieved

Expert Commentary on Complex Revision Rhinoplasty

This case clearly demonstrates the strengths—and challenges—of performing complex reconstruction through closed rhinoplasty.

Severe adhesions, damaged cartilage, misaligned implants, and nostril deformities were all addressed while preserving the advantages of the endonasal approach. Extensive rib cartilage reconstruction was essential to achieving a stable and natural outcome.

Excessively raising the nasal bridge increases the risk of implant displacement or bending, and the glabella must be designed with precision because its height significantly affects the patient’s appearance.

Although perfect symmetry was not achievable due to prior nostril reduction, this surgery achieved meaningful functional and aesthetic improvement.

Table photos after surgery. Frontal view, side view, and oblique angle view.

Nostril photo.

Conclusion

Revision rhinoplasty requires a highly individualized, meticulous approach. With proper technique and experience, natural and balanced results can be achieved through closed rhinoplasty, without external scarring.

Patients considering revision procedures should consult an experienced specialist to determine the most suitable approach for their unique anatomy.

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