Upturned Nose Columella Reconstruction with Rib Cartilage
- Dr. Chayoung Kang
- 2025년 1월 3일
- 5분 분량
최종 수정일: 5월 14일
This case reviews upturned nose columella reconstruction in a patient with a severely upturned nasal tip, thick columella, nostril asymmetry, pinched nasal deformity, scar tissue, and functional airway limitation after multiple previous rhinoplasty procedures. Reconstruction focused on septal support, alar cartilage rebuilding, columella reshaping, foreign material removal, and nasal airway correction.
Author: Dr. Cha-Young Kang
Clinic: NoseLab Clinic
Published: 2025
Last Updated: 2026
Introduction
Hello, this is Dr. Cha-Young Kang of NoseLab Clinic.
This case involves upturned nose columella reconstruction in a patient with a severely upturned nasal tip, thickened columella, significant nostril asymmetry, and pinched nasal deformity after multiple previous rhinoplasty procedures.
The surgery was performed using a closed rhinoplasty / endonasal approach with autologous rib cartilage reconstruction. The goal was to rebuild nasal support, correct the upturned tip, reduce excessive columella thickness, improve nostril balance, and address functional airway limitation.
Case Background
The patient presented with a severely upturned nasal tip, thick and overdeveloped columella, and significant asymmetry following multiple prior rhinoplasty procedures.
Repeated surgeries, inflammation, and scar contracture led to structural collapse, distorted nasal shape, and functional impairment. The nasal framework had become shortened and unstable, while scar tissue and possible foreign material remnants contributed to stiffness and asymmetry.
Key Concerns
The key concerns included:
Upturned nasal tip
Thick and overdeveloped columella
Severe nostril asymmetry
Pinched nasal deformity
Short and contracted nasal structure
Scar tissue and foreign material remnants
Functional airway limitation
This case required structural reconstruction rather than simple aesthetic correction because the nasal support system and airway function were both affected.
Preoperative Design and Structural Assessment
Preoperative design consultation photos were reviewed from the frontal, side, oblique, and nostril views.
The frontal view showed nasal asymmetry, a pinched appearance, and imbalance around the nasal base. The side and oblique views showed a shortened and upturned nasal structure with an abnormal nasolabial angle. The nostril view showed asymmetrical nostrils and a thickened columella.
Structural Problems Identified
The main structural problems included:
Severe septal cartilage loss
Alar cartilage deficiency
Thick columella
Upturned and shortened nasal structure
Scar contracture
Foreign material remnants
Nostril asymmetry
Functional airway compromise
These findings confirmed that the surgery had to address the septum, alar cartilage, columella, nasal tip, nasal base, scar tissue, and internal airway together.
Surgical Approach for Upturned Nose Correction
Upturned nose deformities after revision surgery are often caused by loss of septal support, scar contracture, and abnormal cartilage positioning. When the columella is also thickened and nostrils are asymmetrical, the surgery becomes more complex.
A closed rhinoplasty Korea approach was selected to allow internal structural reconstruction while avoiding an additional external columellar incision. In revision cases with scar tissue and compromised soft tissue, minimizing additional external trauma can be helpful.
Surgical Plan
Septal Reconstruction
Autologous rib cartilage was used to reconstruct the septal support structure. This was necessary because septal cartilage loss had weakened the central nasal framework.
Alar Cartilage Reconstruction
The alar cartilages were reconstructed to improve nasal tip support and nostril stability. Alar cartilage deficiency contributed to the pinched appearance and nostril asymmetry.
Columella Reduction and Reshaping
The thick columella was carefully reduced and reshaped. The goal was to improve proportion and nasal base balance without creating excessive weakness or instability.
Scar Tissue and Foreign Material Removal
Scar tissue and residual foreign materials were removed where necessary. Removing these tissues helped create a cleaner foundation for reconstruction and reduced sources of stiffness or distortion.
Tip De-rotation and Structural Support
The upturned nasal tip was corrected through structural support and tip repositioning. Rib cartilage support helped improve tip stability and reduce the shortened appearance.
Nasolabial Angle Correction
The nasolabial angle was adjusted by repositioning the nasal tip and rebuilding septal support. This helped improve the relationship between the columella and upper lip.
Functional Correction
Functional correction included septal straightening, nasal valve reinforcement, and treatment for rhinitis-related obstruction. These steps were planned to improve internal airflow as well as structural stability.
Surgical Results
Frontal View
From the frontal view, the nasal contour appeared more balanced, and nostril exposure was reduced. The nasal base and tip alignment also showed improved symmetry after reconstruction.
Side View
From the side view, the upturned nasal tip was corrected to a more stable position. The nasolabial angle appeared more balanced after septal support and tip repositioning.
Oblique View
The oblique view showed improved contour harmony and structural balance. The transition from the nasal bridge to the tip appeared smoother after reconstruction.
Nasal Base View
From the nasal base view, nostril symmetry improved, and the columella width appeared more proportionate. The nasal base looked less pinched after alar cartilage reconstruction and columella reshaping.
Functional Outcome
Airway function improved after septal straightening, nasal valve reinforcement, and rhinitis treatment. The reconstructed nasal framework also provided more stable support for internal airflow.
Surgeon’s Commentary
Upturned nose correction in revision cases requires structural reconstruction rather than simple repositioning. When the septum and alar cartilages are weakened, the nasal tip can rotate upward again if the support system is not rebuilt.
In this case, severe septal and alar cartilage loss required reconstruction using autologous rib cartilage. Rib cartilage provided the support needed to rebuild the nasal framework and stabilize the nasal tip.
The thick columella and scar contracture also required careful management. Reducing the columella alone would not have been enough; the underlying support and nasal base structure needed to be corrected at the same time.
Removal of scar tissue and foreign material remnants helped reduce stiffness and distortion. Functional correction was also important because the patient had airway limitation as well as external deformity.
This case shows that upturned nose columella reconstruction should be planned as a combined structural, aesthetic, and functional revision rather than a simple tip correction.
FAQ
Why does the nose become upturned after rhinoplasty?
An upturned nose can occur after loss of septal support, scar contracture, cartilage malposition, or postoperative inflammation. When the internal framework weakens, the nasal tip may rotate upward and the nostrils may become more visible.
Can a thick columella be corrected during revision rhinoplasty?
Yes, a thick columella can be corrected through controlled reshaping. However, the underlying septal support and nasal base structure must also be evaluated to avoid weakening the nose.
Why is rib cartilage used for upturned nose columella reconstruction?
Rib cartilage is often used when septal or alar cartilage is insufficient. It provides stronger support for septal reconstruction, tip repositioning, alar cartilage repair, and long-term structural stability.
Can breathing improve after this type of revision surgery?
Breathing can improve when septal deviation, nasal valve weakness, and rhinitis-related obstruction are corrected. Functional improvement depends on the patient’s internal nasal condition and airway findings.
International Consultation
For international patients, a photo-based consultation may help clarify whether upturned nose correction, columella reconstruction, rib cartilage support, nostril asymmetry correction, or functional airway treatment may be needed.
WhatsApp: https://wa.me/821057360302
LINE: [LINE Link]
Home page : www.noselab.co.kr
Instagram : noselab_global
YouTube : Noselab
Email : noselab@naver.com
댓글