Upturned Nose Correction with Rib Cartilage Reconstruction
- Dr. Chayoung Kang
- 2024년 12월 11일
- 5분 분량
This case reviews upturned nose correction with rib cartilage in a patient with a history of multiple nasal surgeries, severe nasal obstruction, excessive nostril exposure, upturned nasal tip, wide nasal bridge, low nasal dorsum, large nasolabial angle, mouth protrusion impression, nostril asymmetry, left-tilted columella deviation, nasal adhesion, internal nasal valve weakness, septal deviation, and turbinate enlargement. Surgery focused on full septal reconstruction with autologous rib cartilage, nostril lowering, nasal adhesion release, internal nasal valve reconstruction, septoplasty, turbinate reduction with submucosal resection, 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 with rib cartilage in a patient who experienced nasal obstruction and an upturned nose after multiple previous nasal surgeries.
The patient’s main concerns included severe nasal obstruction, especially on the right side, excessive nostril exposure, an upturned nasal tip, low nasal dorsum, wide nasal bridge, nostril asymmetry, and columella deviation.
The surgery was performed using a closed rhinoplasty / endonasal approach. The goal was to reconstruct the septal framework with rib cartilage, lower the nostril exposure, improve tip rotation, release nasal adhesion, support the internal nasal valve, correct septal deviation, and address turbinate-related obstruction.
Surgical History
The patient had undergone several nasal procedures before visiting NoseLab Clinic. Because multiple surgeries can affect septal cartilage, scar tissue, internal nasal lining, and airway structure, revision planning required both external and internal nasal evaluation.
Patient’s Past Procedures
The previous surgical history included:
9 years ago: Ear cartilage and silicone implant
3–4 years ago: Nasal obstruction surgery, septoplasty, ear cartilage, and silicone implant
2.5 years ago: Silicone implant removal
The patient preferred rib cartilage because of concerns related to infection and previous implant history.
Key Symptoms and Goals
The patient presented with both functional and aesthetic concerns. Breathing difficulty was a major issue, and the nasal tip appeared over-rotated with excessive nostril exposure.
Main Concerns
The main concerns included:
Severe nasal obstruction, worse on the right side
Excessive nostril exposure
Upturned nasal tip
Desire for increased nasal height
Preference for rib cartilage due to infection concerns
Wide nasal bridge
Low nasal dorsum
Nostril asymmetry
Columella deviation
These findings suggested that correction should not focus only on external shape. Functional airway correction and septal reconstruction were also needed.
Preoperative Analysis
Preoperative design consultation photos were reviewed from the frontal, side, oblique, and nostril views.
Frontal View
The frontal view showed excessive nostril exposure, asymmetrical nostrils, and a wide nasal bridge.
The nostril exposure was related to the upturned nasal tip, septal support, and lower nasal framework imbalance.
Side View
The side view showed a pronounced upturned nose, a large nasolabial angle, mouth protrusion impression, and low nasal dorsum.
The relationship between the nasal tip, columella, upper lip, and dorsum was evaluated together.
Oblique View
The oblique view showed an over-rotated nasal tip and mouth prominence.
This confirmed that tip rotation and lower nasal support needed to be corrected together.
Nostril View
The nostril view showed nostril asymmetry and a columella tilted to the left.
Because nostril shape is influenced by the septum, columella, alar support, and scar tissue, lower nasal framework correction was included in the surgical plan.
Surgical Approach
The surgical approach included structural reconstruction, nostril lowering, and functional airway correction.
Full Septal Reconstruction with Rib Cartilage
Autologous rib cartilage was used for full septal reconstruction.
This was needed because the previous surgeries had affected the septal structure and central nasal support.
The reconstructed septal framework helped support the nasal tip, columella, nostril position, and internal airway.
Structural Correction to Reduce Nostril Exposure
The nasal tip was repositioned and supported to reduce excessive nostril exposure.
Nostril lowering was performed to improve frontal nostril show and lower nasal balance.
The goal was to improve tip rotation without excessive lengthening or an artificial appearance.
Nasal Adhesion Release
Nasal adhesion was released to improve the internal nasal passage.
In revision cases, adhesion can contribute to nasal obstruction and discomfort, so it must be evaluated during functional correction.
Internal Nasal Valve Reconstruction
Internal nasal valve support was reconstructed because valve weakness can contribute to airflow limitation.
This step was included to support the airway structure together with septal reconstruction.
Septoplasty
Septoplasty was performed to correct septal deviation.
Because the septum affects both nasal shape and airflow, septal correction was planned together with rib cartilage reconstruction.
Turbinate Reduction with Submucosal Resection
Turbinate reduction with submucosal resection was performed to address turbinate-related obstruction.
Functional improvement depends on septal alignment, turbinate response, mucosal condition, swelling, and healing process.
Postoperative Results
Structural Result
After surgery, the nasal tip appeared more supported after rib cartilage reconstruction.
The septal framework was reconstructed to support nasal height, tip position, columella alignment, and airway structure.
The nasal height appeared more balanced after structural correction.
Aesthetic Result
Excessive nostril show was reduced after nostril lowering and tip support.
The upturned nasal tip appeared corrected within a controlled range, and the nasal bridge appeared smoother after structural refinement.
The overall nasal shape appeared more balanced without excessive projection.
Functional Result
Septal deviation, nasal adhesion, internal nasal valve weakness, and turbinate-related obstruction were addressed together.
The internal nasal valve appeared better supported after reconstruction, and the septal structure appeared straighter after correction.
Because nasal obstruction can be affected by swelling, scar tissue, mucosal condition, valve support, turbinate response, and healing process, breathing changes should be evaluated over time.
Surgeon’s Commentary
The key point in this case was reconstruction of the septal framework using autologous rib cartilage.
In upturned nose revision rhinoplasty, the septum often plays a central role. If the septal cartilage is missing, weakened, or structurally insufficient, the nasal tip may remain over-rotated, and nostril exposure may persist.
In this case, rib cartilage was used to reconstruct the septum and support the nasal tip, columella, nostril position, and airway.
Functional correction was also important because the patient had severe nasal obstruction. Adhesion release, internal nasal valve reconstruction, septoplasty, and turbinate reduction were performed together.
This case shows that upturned nose correction with rib cartilage may require combined correction of nasal tip rotation, nostril exposure, septal support, internal nasal valve structure, nasal adhesion, septal deviation, and turbinate enlargement.
FAQ
What is upturned nose correction with rib cartilage?
Upturned nose correction with rib cartilage is revision rhinoplasty planned to lower an over-rotated nasal tip, reduce nostril exposure, and reconstruct nasal support using the patient’s own rib cartilage when stronger support is needed.
Why is rib cartilage used in upturned nose revision rhinoplasty?
Rib cartilage may be used when septal cartilage is missing, weakened, damaged, or insufficient after previous surgery. It can help rebuild central nasal support and support the nasal tip and airway.
Can nostril exposure be reduced?
Nostril exposure may be reduced through nasal tip repositioning, septal reconstruction, nostril lowering, columella support, and lower nasal framework correction. The degree of improvement depends on tissue condition and healing response.
Can nasal obstruction improve after upturned nose correction?
Breathing may improve when septal deviation, nasal adhesion, internal nasal valve weakness, or turbinate enlargement is corrected. The degree of improvement depends on internal anatomy, mucosal condition, scar tissue, and healing.
Is closed rhinoplasty possible for this type of revision?
A closed rhinoplasty / endonasal approach may be used in selected revision cases depending on scar tissue, septal condition, valve structure, nasal lining, and reconstruction needs.
International Consultation
For international patients, a photo-based consultation may help clarify whether upturned nose correction with rib cartilage, full septal reconstruction, nostril lowering, adhesion release, internal nasal valve reconstruction, septoplasty, or turbinate reduction may be needed.
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