Case Study: Structural Stability Recovery for Over-Operated Upturned Nose

Hello, this is Dr. Cha-Young Kang, Director of Nose Lab Clinic.

Today, I’d like to share a case involving the correction of a structurally compromised upturned nose following multiple previous surgeries.

Often, the external appearance of the nose differs significantly from its internal condition, and this case exemplifies that challenge.

1. Surgical History and Patient Goals

Surgical History:

• 23 years ago: Auricular cartilage graft

• 13 years ago: Silicone implant

• 10 years ago: Septal cartilage + Auricular cartilage + Silicone implant

Patient Goals:

Design Consultation: Frontal View, Left Oblique Side View, and Side View Photos

• Reduce visible nostril exposure

• Shorten the apparent philtrum length

• Correct upturned nasal tip

Design Consultation: Right Side View, Oblique Side View, and Nostril View Photos

2. Preoperative Analysis

a. Frontal View:

Before (Left) / Immediately After (Right)

• Excessive nostril show

• Nostril asymmetry

• Crooked nasal bridge

• Wide nasal dorsum

b. Side View:

Before (Left) / Immediately After (Right)

• Upturned nasal tip

• High nasal starting point

• Protruding mouth appearance

c. Oblique View:

Before (Left) / Immediately After (Right)

• Depressed columella

• High nasal starting point

d. Nostril View:

Before (Left) / Immediately After (Right)

Severe asymmetry

3. Intraoperative Findings and Surgical Plan

a. Identified Structural Problems

• Excessive harvest of septal cartilage, resulting in septal collapse

• Residual septum deviated entirely to the right

• Severely damaged alar cartilage

b. Reconstruction Strategy

1. Septal Cartilage Reconstruction:

   • Rebuilt the septum using autologous rib cartilage.

   • Moved the septum back to the midline for structural balance.

2. Alar Cartilage Reconstruction:

   • Repurposed previously used auricular cartilage to reconstruct the alar cartilage.

3. Septal Extension:

   • Used rib cartilage to extend the septum and lower the upturned nasal tip.

4. Surgical Outcomes

Immediately After Surgery: Frontal, Side, and Oblique Side View Photos

Immediately After Surgery: Nostril View Photos

a. Structural Improvements:

• Septum successfully reconstructed in the midline.

• Both alar cartilages effectively reconstructed.

• Rib cartilage extension provided robust support, stabilizing and lowering the nasal tip.

b. Aesthetic Enhancements:

• Reduced visible nostril exposure.

• Achieved a natural nasal tip position.

• Improved nostril symmetry.

• Shortened the apparent philtrum length, creating a more balanced facial profile.

• Lowered the starting point of the nasal bridge, adding natural contour and dimension.

5. Specialist Insight

This case highlights the complexity of reconstructing a nose with severe structural damage from multiple prior surgeries. Extensive damage to the septum and alar cartilages posed significant challenges. However, using autologous rib cartilage and salvaged auricular cartilage allowed us to achieve a stable, functional, and aesthetically pleasing result.

Proper structural reinforcement is essential to prevent future deformities and ensure lasting results. This underscores the importance of precise surgical planning and the judicious use of available materials, especially in revision cases.

6. Closing Remarks

At Nose Lab Clinic, we are committed to delivering the best outcomes, even for the most challenging revision cases.

For those struggling with similar concerns, I hope this case provides clarity and reassurance about the possibilities of reconstruction.

This is Dr. Cha-Young Kang, Director of Nose Lab Clinic.

Thank you.