Hello, this is Dr. Cha-Young Kang, head surgeon at Nose Lab Clinic.
Today, I’d like to share a rhinoplasty case involving a patient concerned with a crooked nose, a bulbous nasal tip, and asymmetrical nostrils. This patient had already undergone two previous rhinoplasties and came to us for a third revision.
1. Patient History
The patient had the following surgical history:
4 years ago: Tipplasty and nostril lowering
2022: Dorsal and tip surgery using silicone and autologous rib cartilage
2. Patient's Requests
The patient primarily wanted the following:
Correction of the crooked nose
Improvement of the uneven surface of the nasal bridge
Maintain the current height of the nose
Resolution of an occasional unpleasant smell from inside the nose
3. Pre-Surgery Design Consultation
We performed a detailed analysis of the patient's pre-surgery condition, observing the following:
Pre-Surgery Design Consultation: Frontal, Left Oblique, and Left Profile Views
Frontal View:
The nasal bridge appears bent toward the right side.
The nasal tip deviates toward the left.
The nasal tip looks bulbous and lacks definition.
Asymmetry in the nostrils is clearly visible.
Oblique View:
The starting point of the nasal bridge is high.
The nasal tip appears droopy.
Profile View:
The nasal bridge is high.
The nasal tip droops, giving an imbalanced look.
The nasal bridge appears uneven and bumpy.
Pre-Surgery Design Consultation: Right Oblique, Right Profile, and Nostril Views
Nostril View:
Nostril asymmetry is prominent.
The columella leans toward the left.
The nasal tip looks wide and spread out, contributing to an overall bulky appearance.
4. Surgical Plan
Considering the patient’s condition and requests, the following surgical plan was developed:
a) Correction of Deviated Septum and Septal Reconstruction Using Autologous Rib Cartilage
b) Septal Extension to Correct the Deviated Nasal Tip
c) Dermal Graft to Cover the Protruding Cartilage at the Tip
d) Lateral Osteotomy to Straighten the Crooked Nasal Bridge
e) Removal of the Existing Silicone Implant and Insertion of a New Implant
f) Correction of Nostril Asymmetry through Septal Realignment and Repositioning of Alar Cartilage
5. Surgical Procedure
The surgery was performed using a closed (endonasal) approach, with the following steps:
a) Autologous Rib Cartilage Harvesting and Septal Reconstruction:
A 2.5 cm incision was made below the previous rib cartilage harvesting site to extract the cartilage.
The harvested cartilage was used to correct the deviated septum and reconstruct the nasal septum, ensuring structural stability and laying the foundation for the correction of the crooked nose.
b) Septal Extension:
The reconstructed septal cartilage was extended and strengthened to correct the deviation of the nasal tip.
This provided the necessary support to realign the nasal tip.
c) Dermal Graft:
Dermis was grafted over the area where the nasal tip cartilage was protruding through the skin.
This improved the skin’s thickness and created a smoother, more natural appearance.
d) Lateral Osteotomy:
A precise lateral osteotomy was performed to straighten the crooked nasal bridge and refine the overall nasal structure.
e) Replacement of Silicone Implant:
The existing silicone implant was removed and replaced with a new implant, which was placed in the correct position to create a smooth and even dorsal line.
f) Correction of Nostril Asymmetry:
The septum was realigned, and the alar cartilage was repositioned to center the nasal structure.
Cartilage stitching was performed to enhance the symmetry of the nostrils.
All procedures were completed using a closed approach, ensuring no external scars while effectively addressing both structural and aesthetic concerns.
6. Before and After Photo Comparison
Upon reviewing the post-surgery photos, the following improvements are evident:
Frontal view before surgery (left) after surgery (right)
Frontal View:
The previously crooked nasal bridge, which bent to the right, has been straightened.
The nasal tip, which deviated to the left, is now aligned centrally.
The bulbous nasal tip has been naturally refined, creating a more defined appearance.
45-degree angle view before surgery (left) after surgery (right)
Oblique View:
The high starting point of the nasal bridge has been lowered to a more natural level.
The droopy nasal tip has been lifted, enhancing the overall facial balance and harmony.
Side profile view before surgery (left) after surgery (right)
Profile View:
The uneven, bumpy appearance of the nasal bridge has been smoothed out.
The previously droopy nasal tip has been elevated, creating a more proportional and refined profile.
The overall contour of the nose has become softer and more natural.
Nostrils before surgery (left) after surgery (right)
Nostril View:
The nostril asymmetry has been significantly improved, resulting in a more balanced appearance.
The columella, which had tilted to the left, is now centered.
The wide and bulky appearance of the nasal tip has been refined, giving it a more elegant shape.
7. Collection of Photos Immediately After Surgery
Photos taken immediately after surgery, frontal view, 45-angle view, and side profile.
Photo of the nostrils
8. Final Evaluation
This case involved the correction of complex nasal issues for a patient with a history of multiple surgeries, including a crooked nose, bulbous nasal tip, and nostril asymmetry. The successful outcome was achieved by utilizing the advantages of the closed (endonasal) approach, which allowed us to address multiple concerns while maintaining a natural result.
A key aspect of this surgery was the correction of the deviated septum. In cases where the nasal tip is raised significantly, septal deviation must be corrected to prevent the tip from becoming misaligned. In this patient’s case, we were able to secure structural stability and correct the deviation by using autologous rib cartilage for septal reconstruction and extension.
Additionally, a crucial part of this surgery involved improving the appearance of the nasal tip, which had become unnatural following previous nostril lowering procedures. While nostril lowering can sometimes result in an unbalanced nasal tip, we were able to correct and reshape the tip to restore a more natural appearance.
9. Closing Remarks
For those struggling with complex nasal issues, such as a crooked nose, bulbous tip, or nostril asymmetry, I hope this case provides helpful insights. Particularly for patients with multiple surgeries in their history, it’s essential to take a comprehensive approach that considers the overall structure and balance of the nose, not just isolated problems.
At Nose Lab Clinic, we leverage our deep anatomical knowledge as ENT specialists and extensive surgical experience to provide customized surgical plans for each patient. By utilizing a closed (endonasal) approach, we can resolve complex nasal issues without leaving external scars, allowing for quicker recovery and more natural results.
If you are considering rhinoplasty, especially revision surgery, I strongly recommend consulting with an experienced specialist to find the best approach for your unique needs. At Nose Lab Clinic, we are committed to helping you achieve a beautiful and healthy nose.
This has been Dr. Cha-Young Kang, head surgeon at Nose Lab Clinic.
Thank you.
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