Hello, this is Dr. Cha-Young Kang, head surgeon at Nose Lab Clinic.
Today, I’d like to introduce a case involving a male patient with multiple rhinoplasty procedures who experienced several complications, including a contracted nose, upturned tip, and shortened nasal length. This case highlights the challenges and solutions involved in correcting a contracted nose.
1. Patient History
This patient had the following surgical history:
2017: Septoplasty + Silicone implant
2020: Silicone + Autologous rib cartilage graft
December 2023: Silicone + New autologous rib cartilage graft
3 months later, the nasal tip became swollen and red like a balloon, requiring incision
Same day: Irrigation + Implant removal
2. Patient's Requests
Correction of nasal obstruction (occasional loss of taste during meals)
Nasal reconstruction
A straight nasal line
A sleek, refined nose shape
3. Pre-Surgery Design Consultation
Let’s perform a detailed analysis of the patient’s pre-surgery condition:
Pre-Surgery Design Consultation: Right Oblique, Right Profile, and Nostril Views
Frontal View:
Upturned Nasal Tip
Asymmetry of the Nostrils
Excessive Nostril Show
Wide and Curved Nasal Bridge
Oblique View:
Short and Droopy Nose
Profile View:
Depressed Nasal Tip
Protruded Upper Lip
Short Nose
Pre-Surgery Design Consultation: Right Oblique, Right Profile, and Nostril Views
Nostril View:
Scar on the Nasal Tip
Asymmetry of Nostrils
Scar Tissue on Right Side of Columella
4. Surgical Plan
To address the patient’s complex issues, the following surgical plan was developed:
a) Stem Cell Injection Therapy:
A series of 5 stem cell injections were administered at two-week intervals before surgery.
The 6th stem cell injection was given on the day of surgery to promote tissue regeneration and reduce the likelihood of recurrence of contraction.
b) Autologous Rib Cartilage Harvesting:
Since the patient had previous cartilage harvested from the right side, this time cartilage was harvested from the left side.
c) Septal Cartilage Reconstruction and Correction:
Autologous rib cartilage was used to reconstruct the septal cartilage.
The deviated septum, which was tilted to the right, was corrected to improve nasal breathing and restore structural stability.
d) Nostril Correction:
A nostril lowering procedure was performed to correct the asymmetry of the nostrils.
e) Nasal Tip Correction:
The nasal tip was lowered using septal extension grafting with autologous rib cartilage.
The columella was adjusted to improve the nasolabial angle, contributing to the correction of the protruded upper lip.
f) Nasal Bridge Correction:
A silicone implant was used to create a natural straight nasal line.
The previously wide and crooked appearance of the nasal bridge was corrected to form a slim and straight profile.
g) Scar Improvement on Nasal Tip:
The depressed scar on the nasal tip was improved by grafting dermis and cartilage beneath the skin to smooth the surface.
5. Surgical Procedure
The surgery was performed using a closed (endonasal) approach, with the following steps:
a) Stem Cell Injection Therapy:
Five stem cell injections were administered prior to surgery to promote tissue regeneration and prepare the nasal tissue for the operation.
A sixth injection was given on the day of surgery to aid in post-operative healing and reduce the risk of re-contraction.
b) Autologous Rib Cartilage Harvesting:
A sufficient amount of rib cartilage was harvested from the left side of the patient.
This cartilage was used for septal reconstruction, tip correction, and nasolabial angle adjustment.
c) Septal Cartilage Reconstruction and Correction:
The harvested rib cartilage was used to reconstruct the damaged septum.
The deviated septum was corrected to improve nasal airflow and restore the nose’s structural integrity.
d) Nostril Correction:
The asymmetrical and upturned nostrils were corrected by lowering them, resulting in a more balanced appearance.
e) Nasal Tip Correction:
A septal extension graft using rib cartilage was performed to lower the upturned nasal tip.
The columella was adjusted, improving the nasolabial angle and contributing to the correction of the protruded upper lip.
f) Nasal Bridge Correction:
A silicone implant was placed to create a straight nasal line.
The previously wide and crooked appearance of the nasal bridge was corrected, giving the nose a slimmer and more defined look.
g) Scar Improvement on Nasal Tip:
The depressed scar on the nasal tip was addressed by grafting dermis and cartilage under the skin to smooth the surface and improve the overall appearance.
All steps were performed using a closed approach, allowing the surgery to be completed without any external scarring. This ensured a natural, scar-free outcome while addressing both functional 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 upturned nasal tip has been naturally lowered, reducing the visibility of the nostrils.
The asymmetry of the nostrils has been corrected, creating a more balanced and harmonious appearance.
The previously wide and crooked nasal bridge now appears slimmer and straighter, enhancing the overall facial profile.
45-degree angle view before surgery (left) after surgery (right)
Oblique View:
The nose, which appeared short and droopy, is now longer and more lifted, improving the overall facial balance.
The nasal line is now smooth and natural, contributing to a more refined and aesthetically pleasing appearance.
Side profile view before surgery (left) after surgery (right)
Profile View:
The previously depressed nasal tip has been elevated, improving the overall height of the nose.
The protruded upper lip appearance has been corrected, resulting in better harmony between the nose and the rest of the face.
The length of the nose has been extended, providing a more balanced and proportionate look.
Nostrils before surgery (left) after surgery (right)
Nostril View:
The depressed scar on the nasal tip has been smoothed out, resulting in a more even and refined surface.
The asymmetry of the nostrils has been significantly improved.
The scar tissue protruding from the right side of the columella has been corrected, resulting in a more natural and smooth appearance.
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 following multiple rhinoplasty surgeries, including a contracted nose, upturned tip, short nose, and skin depression on the nasal tip. The surgery required meticulous planning and advanced surgical techniques to address the combination of these challenges.
One key factor that contributed to the success of this case was the use of stem cell injection therapy before the surgery. These injections promoted tissue regeneration, enhanced healing, and helped reduce the risk of post-surgical contraction, which is often a concern in contracted nose cases.
The use of autologous rib cartilage was crucial. In cases of contracted noses, the nose has a tendency to contract even more post-surgery, so a strong, durable structural material was needed. Autologous rib cartilage provided the necessary strength and volume without the risk of rejection, making it an ideal choice
By incorporating multiple surgical techniques, including septal reconstruction, nasal tip correction, and nasolabial angle adjustment, we were able to meet the patient's varied needs. Additionally, correcting the deviated septum improved not only the aesthetic outcome but also the patient's breathing, making this a case that achieved both functional and cosmetic improvement.
9. Closing Remarks
For those struggling with complex nasal issues such as contracted noses, upturned tips, or short noses, we hope this case offers reassurance and hope. Even after multiple surgeries, satisfactory results can be achieved through careful surgical planning and the right techniques.
In cases of contracted noses, the strong tendency for post-surgical contraction requires a durable structural material to maintain results. This is why autologous rib cartilage is so important—it provides both safety and efficacy, making it a widely recognized solution.
At Nose Lab Clinic, we leverage our deep anatomical knowledge and extensive surgical experience as ENT specialists to create personalized surgical plans tailored to each patient's unique situation. If you are considering rhinoplasty, especially revision surgery, we encourage you to consult with a specialist to find the best approach for your individual needs.
We at Nose Lab Clinic 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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