Case at a glance
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This case reviews upturned nose correction revision rhinoplasty in a patient with a history of multiple nasal surgeries, excessive nostril exposure, nostril asymmetry, crooked nasal bridge, wide nasal dorsum, upturned nasal tip, high nasal starting point, protruding mouth impression, depressed columella, excessive septal cartilage harvest, rightward septal deviation, and damaged alar cartilage. Surgery focused on rib cartilage septal reconstruction, septal extension grafting, alar cartilage reconstruction using salvaged auricular cartilage, nostril exposure correction, nasal tip repositioning, columella support, and closed rhinoplasty structural correction.
Author: Dr. Cha-Young Kang
Clinic: NoseLab Clinic
Published: 2024
Last Updated: 2026
Introduction
Hello, this is Dr. Cha-Young Kang of NoseLab Clinic.
This case involves upturned nose correction revision rhinoplasty in a patient who had undergone multiple previous nasal surgeries and later developed structural weakening, excessive nostril exposure, and an upturned nasal tip.
The patient was concerned about visible nostril exposure, a shortened philtrum impression, nasal tip rotation, nostril asymmetry, and overall nasal imbalance.
The surgery was performed using a closed rhinoplasty / endonasal approach. The goal was to reconstruct the damaged septal support, reposition the nasal tip, reduce nostril exposure, reconstruct weakened alar cartilage, improve columella support, and create a more balanced nasal contour.
Surgical History Before Upturned Nose Correction Revision Rhinoplasty
The patient had undergone several previous nasal procedures over more than two decades. Repeated surgery had affected the septal cartilage, alar cartilage, and lower nasal support.
Previous Surgical History
The surgical history included:
23 years ago: auricular cartilage graft
13 years ago: silicone implant
10 years ago: septal cartilage, auricular cartilage, and silicone implant
Because the patient had a long surgical history, the revision plan needed to account for scar tissue, cartilage availability, and weakened nasal support.
Preoperative Analysis for Upturned Nose Correction Revision Rhinoplasty
Preoperative design consultation photos were reviewed from the frontal, side, oblique, and nostril views.
Frontal View: Nostril Exposure and Nasal Deviation
The frontal view showed excessive nostril show, nostril asymmetry, a crooked nasal bridge, and a wide nasal dorsum.
The nostril exposure was related to the upturned nasal tip, weak septal support, and lower nasal framework imbalance.
Side View: Upturned Tip and High Nasal Starting Point
The side view showed an upturned nasal tip, high nasal starting point, and protruding mouth impression.
The relationship between the radix, nasal tip, columella, and upper lip was evaluated together.
Oblique View: Depressed Columella
The oblique view showed a depressed columella and high nasal starting point.
This suggested that columella support and tip position needed to be corrected together.
Nostril View: Severe Nostril Asymmetry
The nostril view showed severe asymmetry.
Because nostril shape depends on septal support, columella position, alar cartilage, and scar tissue, lower nasal framework reconstruction was included in the surgical plan.
Patient Goals for Upturned Nose Correction Revision Rhinoplasty
The patient wanted the upturned nasal tip and visible nostril exposure to be corrected while maintaining a balanced and natural-looking nasal contour.
Main Goals
The goals included:
Reduce visible nostril exposure
Shorten the apparent philtrum length
Correct the upturned nasal tip
Improve nostril symmetry
Improve nasal tip position
Support the weakened nasal framework
Create a more balanced frontal and side profile
Because the patient had internal structural damage from previous surgeries, the plan required reconstruction rather than surface-level contour correction alone.
Intraoperative Findings and Surgical Plan
Identified Structural Problems
During surgery, several structural problems were identified.
The septal cartilage had been excessively harvested during previous surgery, resulting in weakened central support.
The remaining septum was deviated to the right, and the alar cartilage was severely damaged.
These findings explained why the nasal tip appeared lifted, the nostrils were asymmetric, and the columella support was insufficient.
Rib Cartilage Septal Reconstruction
Autologous rib cartilage was used to reconstruct the weakened septal framework.
The reconstructed septal support was repositioned toward the midline to improve central nasal balance.
This step was important for supporting the nasal tip, columella, nostril position, and overall lower nasal structure.
Alar Cartilage Reconstruction Using Auricular Cartilage
Salvaged auricular cartilage was used to reconstruct the damaged alar cartilage.
This helped reinforce the lower nasal framework and improve nostril shape.
Because alar cartilage condition affects nostril contour and tip definition, reconstruction was planned together with septal support.
Septal Extension with Rib Cartilage
A septal extension graft using rib cartilage was used to support and reposition the nasal tip.
This helped lower the over-rotated tip and reduce excessive nostril exposure within a controlled range.
The goal was to improve tip position without excessive lengthening or an artificial appearance.
Surgical Results After Upturned Nose Correction Revision Rhinoplasty
Structural Result After Rib Cartilage Septal Reconstruction
The septal framework was reconstructed closer to the midline using rib cartilage.
The alar cartilages were reinforced using salvaged auricular cartilage, and the lower nasal support appeared improved after structural correction.
Because this was a complex revision case, the result was planned within the limits of scar tissue, remaining cartilage, skin condition, and healing response.
Frontal View: Reduced Nostril Exposure
From the frontal view, visible nostril exposure was reduced after tip repositioning and septal extension.
Nostril balance improved after reconstruction of the septal support and alar cartilage.
Side View: Improved Tip Position and Profile Balance
From the side view, the nasal tip appeared less upturned after rib cartilage septal extension.
The high nasal starting point and protruding mouth impression appeared more balanced in relation to the revised nasal profile.
Nostril View: Improved Lower Nasal Balance
From the nostril view, the nostril asymmetry improved after alar cartilage reconstruction and septal support correction.
The lower nasal framework appeared more balanced after combined reconstruction of the septum, alar cartilage, and columella support.
Overall Structural Outcome
The upturned nasal tip, excessive nostril exposure, nostril asymmetry, depressed columella, and weakened structural support were corrected together.
Because the patient had severe internal damage from previous surgeries, the outcome was planned as a structural reconstruction rather than a simple tip correction.
Surgeon’s Commentary
This upturned nose correction revision rhinoplasty case was challenging because the patient had severe internal damage from multiple previous surgeries.
The most important finding was excessive septal cartilage harvest. When the septum is weakened or depleted, the nasal tip may lose support and become upturned over time.
In this case, autologous rib cartilage was used to reconstruct the septal framework and support the nasal tip.
The alar cartilage was also severely damaged, so salvaged auricular cartilage was used to reinforce the lower nasal framework.
Revision rhinoplasty in this type of case requires careful reinforcement of the septum, alar cartilage, columella, and nasal tip support.
This case shows that upturned nose correction revision rhinoplasty may require combined correction of septal damage, alar cartilage damage, nostril exposure, nostril asymmetry, tip rotation, and columella support.
FAQ
What causes an upturned nose after multiple surgeries?
An upturned nose may occur when septal cartilage, tip support, or alar cartilage has been weakened or over-resected during previous surgeries. Scar tissue and tissue contraction can also contribute.
Why is rib cartilage used for upturned nose correction revision rhinoplasty?
Rib cartilage may be used when the septal cartilage is damaged, insufficient, or missing. It can provide stronger support for septal reconstruction and tip repositioning in selected revision cases.
Can nostril exposure be reduced?
Nostril exposure may be reduced by reconstructing septal support, repositioning the nasal tip, correcting the columella, and reinforcing the lower nasal framework. The degree of improvement depends on tissue condition and healing response.
Why is alar cartilage reconstruction needed?
Alar cartilage reconstruction may be needed when the nostril shape, nasal tip contour, or lower nasal support has been damaged by previous surgery or cartilage weakness.
Can closed rhinoplasty be used for complex revision cases?
A closed rhinoplasty / endonasal approach may be used in selected complex revision cases depending on scar tissue, cartilage condition, nasal lining, and reconstruction needs.
International Consultation
For international patients, a photo-based consultation may help clarify whether upturned nose correction revision rhinoplasty, rib cartilage septal reconstruction, alar cartilage reconstruction, nostril exposure correction, septal extension grafting, or closed rhinoplasty structural correction may be needed.
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