Hello, this is Dr. Cha-Young Kang, Director of Nose Lab Clinic. Today, I’d like to share a special journey of rhinoplasty with a patient who recently visited our clinic.
A young woman in her twenties came to see us, having previously undergone rhinoplasty in 2018. Her initial surgery involved septal cartilage, mesh insertion, and osteotomy. This time, she wanted a natural refinement of her facial profile from the side and a more understated, “presence-free” look for her nose.
Patient’s Initial Condition
Pre-Surgery Design Consultation: Frontal View and Both Side Views
Upon examination, we observed several issues. The nasal tip appeared broad and bulbous, with the nasal bridge similarly wide. Her nostrils showed noticeable asymmetry. From the side, her nasion (bridge start point) was high, the tip appeared blunt, and her columella was slightly drooping. At an oblique angle, her nose looked generally wide and blunt, with a downward tilt at the tip.
Pre-Surgery Design Consultation: Nostril View and Both Oblique Side Views
To address these concerns, we carefully crafted a comprehensive surgical plan. First, we decided on lateral osteotomies to narrow the nasal width and slightly reduce the bridge height for a lower starting point. To slim down the nasal tip, we planned to remove part of the subcutaneous tissue and reposition the alar cartilages, suturing them for a refined appearance.
To correct her nostril asymmetry, we planned septal reconstruction and extension using autologous rib cartilage. We also included correction of the nasolabial angle to refine the bridge-to-tip connection, using rib cartilage to subtly enhance the bridge’s contour for a more fluid transition.
Unexpected Surgical Challenges
Once we began surgery, we encountered more complexity than expected. The previous surgery had left four separate mesh pieces—two on each side—firmly adhered to surrounding tissue. We carefully removed each piece to ensure minimal trauma to the nasal structures. Additionally, the patient’s septal cartilage had been over-harvested in the previous procedure, causing severe damage, so reconstructing her septum with rib cartilage became essential.
Photos of Removed Mesh Fragments
Despite the challenges, we achieved a satisfying outcome. Her nasal tip, once wide and blunt, appeared elegantly refined. The bridge line smoothed out naturally, and her high nasion was lowered to improve overall facial proportions. Her drooping columella was corrected, achieving the “presence-free” and natural look she desired.
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)
Key Takeaway: Risks of Using Mesh for Nasal Tip Augmentation
One crucial lesson from this case is the risk of using mesh in nasal tip augmentation. Mesh can often cause inflammation and contraction, leading to complications that are both severe and challenging to correct. In this case, the mesh removal process required exceptional care due to the adhesion and the damage it had caused. Therefore, mesh should never be used for nasal tip augmentation in cosmetic procedures.
Final Thoughts
For anyone considering rhinoplasty, especially revision cases, it is crucial to consult a certified specialist who prioritizes safe, proven materials and techniques. The condition of prior surgeries must be carefully assessed, requiring a personalized approach for effective results.
At Nose Lab Clinic, we are committed to your safety and satisfaction. Our team carefully considers each patient’s unique facial structure, skin condition, and desired outcomes to recommend the most appropriate surgical methods. For a natural, healthy nose and a brighter smile, Nose Lab Clinic is here for you.
Thank you,
Dr. Cha-Young Kang, Director of Nose Lab Clinic
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