Hello, this is Dr. Cha-Young Kang, Director of Nose Lab Clinic.
Today, I’d like to share a case of rhinoplasty revision for a patient concerned about nasal asymmetry, an upturned tip, and a widened bridge. The complexity of this case was compounded by a high risk of nasal tip necrosis, making an open surgery approach too dangerous.
1. Patient’s Surgical History and Needs
Surgical History:
Double jaw surgery (one year ago)
Nasal filler injections (5–6 years ago, not dissolved)
Grafted donor rib cartilage, septal cartilage, and silicone implant at a different clinic
Autologous rib cartilage and silicone implant (10 months ago at another clinic)
Emergency surgery to reduce the nasal tip height due to necrosis risk (5 days post-op)
Patient’s Concerns:
Upturned nasal tip
Deviated bridge
Widened nasal structure
Protrusive lip appearance
Depressed nasal tip skin and pigmentation
2. Pre-Surgical Condition Analysis
Front View:
Visible nostrils and a flared nasal appearance
Deviated nasal bridge
Pre-Surgery Design Consultation: Frontal View, Side View, and Oblique Side View
Side View:
Upturned nasal tip
High nasion
Protrusive lip profile
Oblique View:
Noticeably widened nasal structure
Pre-Surgery Design Consultation: Frontal View, Side View, and Oblique Side View
Nostrils:
Skin depression and pigmentation on the right nasal tip
Scar tissue on both sides of the columella
Asymmetrical nostrils
Photos of the Nasal Tip with Skin Depression and Pigmentation
3. Surgical Plan: Strategic Approach to Complex Nasal Issues
Septal Reconstruction: Using autologous rib cartilage for structural support
Nasal Tip Correction: Lowering the tip using a septal extension graft
Deviated Bridge Correction: Lateral osteotomy
Widened Nose Refinement
Protrusive Lip Appearance Correction: Adjusting nasolabial angle
Nostril Asymmetry Correction: Reconstructing the septum, repositioning alar cartilage, and suturing
Skin Depression and Pigmentation Correction: Grafting cartilage and dermis
4. Surgical Process: Addressing Challenges with a Closed Approach
Given the patient’s high risk of nasal tip necrosis, I opted for a closed approach, which enabled us to perform complex corrections while minimizing vascular damage.
Septal Cartilage Damage: The significant upturn in the nasal tip was due to extensive septal cartilage damage from prior surgeries. We used autologous rib cartilage for septal reconstruction.
Circulatory Complications: During surgery, a brief period of reduced blood flow to the nasal tip was observed, causing temporary blanching. Using vasodilators and medications to stabilize blood flow, we addressed the circulatory issues successfully. In an open approach, the risk of skin necrosis would have been much higher.
Skin Depression and Pigmentation: The depressed and pigmented nasal tip skin was due to partial necrosis and scarring from prior procedures. We grafted cartilage and dermis to restore volume and improve skin quality.
5. Post-Surgical Results: Before & After
Before Surgery (Left) / Immediately After Surgery (Right)
Front View:
Reduced visibility of the nostrils
Refined and balanced nasal tip
Straightened bridge
Before Surgery (Left) / Immediately After Surgery (Right)
Side View:
The previously upturned tip is now gently downturned, creating a natural contour.
Nasolabial angle adjusted to approximately 95 degrees, enhancing the overall profile.
Before Surgery (Left) / Immediately After Surgery (Right)
Oblique View:
Slimmed appearance of the nasal bridge and tip
Before Surgery (Left) / Immediately After Surgery (Right)
Nostril View:
Improved skin depression and pigmentation
Scar tissue on both sides of the columella minimized
Balanced nostril symmetry
6. Post-Op Photo Comparison
Photos Immediately After Surgery: Frontal, Side, and Oblique Side Views
Photos Immediately After Surgery: Nostril View
7. Final Thoughts: Safe and Effective Revision with a Closed Approach
This case exemplifies the benefits of closed rhinoplasty, especially in high-risk revisions. By carefully reconstructing the nasal framework with autologous rib cartilage, we were able to restore structure and aesthetics. Additionally, the closed approach allowed us to minimize vascular risk, ensuring the procedure was both safe and effective.
8. Closing Remarks: Safe and Personalized Rhinoplasty for Complex Cases
For patients facing necrosis risks or vascular concerns, revision surgery through an open approach can be exceptionally challenging and risky. A closed approach, like the one we offer at Nose Lab Clinic, provides the same level of precision without the added vascular risk.
If you are struggling with a deviated, upturned, or widened nose, especially after previous surgeries, I encourage you to consult with a specialist to find the safest and most effective method for your needs.
Thank you,Dr. Cha-Young Kang, Director of Nose Lab Clinic
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