The Challenge of a Sixth Rhinoplasty: Correcting an Upturned Nose with a Natural Line

Hello, this is Dr. Cha-Young Kang, Director of Nose Lab Clinic. Today, I'd like to share the complex journey of a patient who underwent a sixth rhinoplasty to achieve a natural, straight nasal line with a subtle curve.

This patient had undergone five rhinoplasty procedures from 2009 to 2014, attempting various methods like septal cartilage, donor rib cartilage, ear cartilage, and silicone implants, but each resulted in unsatisfactory outcomes. Eight years ago, she also had a filler injection to address remaining concerns.

During our initial consultation, we conducted a thorough assessment of her nose and identified several issues:

Pre-Surgery Design Consultation Photos

1. Upturned nasal tip

2. High starting point of the nasal bridge

3. Lack of a soft curve for a natural, straight nasal line

4. Asymmetry in the nostrils

5. Visible alar scars due to aggressive philtrum and nostril reduction

6. Columella scars from multiple open rhinoplasty procedures

Pre-Surgery Design Consultation Photos

Surgical Plan

Taking her concerns into account, we developed a tailored surgical plan:

1. Complete removal of existing foreign materials (filler, silicone implants)

2. Reuse of previously harvested autologous tissues (rib cartilage, septal cartilage, ear cartilage)

3. Additional harvest of autologous rib cartilage to use as the primary material

4. Extension of the septum to delicately refine the nasal tip

5. Placement of a new silicone implant, positioned lower than the previous one

   
   

The surgery presented considerable challenges due to the weakened tissues and extensive scar tissue from previous surgeries. With meticulous care, we proceeded step by step, achieving a successful outcome.

Before Surgery (Left) / Immediately After Surgery (Right)

Before Surgery (Left) / Immediately After Surgery (Right)

Before Surgery (Left) / Immediately After Surgery (Right)

Before Surgery (Left) / Immediately After Surgery (Right)

Results Post-Surgery

Immediately after surgery, her upturned nasal tip was corrected to a more natural position, and the nasal bridge’s starting point was lowered to align with the level of her pupils. The nasolabial angle was adjusted to around 95 degrees, giving her a natural profile, and the crooked portions were improved. The nose now had the subtle, straight line she desired, with a refined tip and a smoother bridge.

This case reinforced the importance of a cautious, specialized approach, especially in revision rhinoplasty. For successful results, we must consider a patient’s surgical history, the state of the remaining tissue, and the desired outcome to formulate the optimal surgical plan.

Furthermore, achieving a natural look requires considering the patient’s overall facial proportions and unique features. Instead of following cosmetic trends, it is essential to design a nose that best complements the individual’s facial structure.

For those considering rhinoplasty, especially revision procedures, I urge you to seek extensive consultations and make thoughtful choices. Consulting with an experienced specialist is particularly vital for finding the most suitable approach in complex cases.

At Nose Lab Clinic, we remain dedicated to prioritizing patient safety and satisfaction, striving for the best outcomes.

Thank you,

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