Correcting a Deviated Nose, Hanging Nasal Tip, and Nostril Asymmetry — A Closed Rhinoplasty Case at Noselab

When patients come to Noselab Plastic Surgery, they often carry a list of concerns they have quietly observed in the mirror for years. In this case, our patient presented with four distinct issues that together affected not only the aesthetic harmony of the face but also her self-confidence: a deviated nose, a hanging nasal tip, an undefined glabella line, and nostril asymmetry. Through closed rhinoplasty — the signature approach of Dr. Chayoung Kang — each concern was addressed in a single, scar-free procedure.

Understanding the Patient’s Concerns

1. Deviated Nose (Crooked Nose)

A deviated nose occurs when the nasal bridge does not run in a straight vertical line from the glabella to the tip. Deviation can originate from the bony dorsum, the cartilaginous mid-vault, the nasal septum, or a combination of all three. In this patient, the deviation was visible from the frontal view and created a subtle but noticeable imbalance across the midface.

Correcting a deviated nose is one of the most technically demanding tasks in rhinoplasty. Simply adding an implant or filler does not straighten the underlying structure — the root cause must be identified and surgically addressed. Dr. Kang performed careful osteotomies and septal repositioning to realign the bony and cartilaginous framework before any augmentation was considered.

2. Hanging Nasal Tip (Ptotic Tip)

A hanging tip — clinically referred to as a ptotic or drooping nasal tip — is characterised by a nasolabial angle that is too acute (typically below 90–95° in Asian patients), giving the impression that the tip points downward. This can make the nose appear longer than it is and can visually shorten the upper lip.

From the lateral (side) view, a hanging tip disrupts the elegant curve from the dorsum through the supratip break to the tip-defining point. Correction requires rotation of the tip complex upward, which Dr. Kang achieves through precise manipulation of the lower lateral cartilages and, where necessary, the columellar strut — all performed through the closed approach without any external incision.

3. Glabella Line Design

The glabella is the smooth area of the forehead just above and between the eyebrows. Its relationship to the nasal dorsum defines the radix — the root of the nose — and determines how the nose integrates with the upper face. An insufficiently defined or overly flat radix can make the nose appear to begin too low, reducing the apparent height of the bridge and making the forehead seem heavy.

In this case, Dr. Kang carefully designed the glabella-to-dorsum transition to create a natural, feminine starting point for the nose. By elevating and defining the radix, the nose gains visual length from the base of the forehead rather than from an overly projected tip — a far more harmonious result.

4. Nostril Asymmetry

Perfect bilateral symmetry of the nostrils is rare in nature, but when asymmetry is pronounced — in shape, size, or orientation — it draws attention away from the overall balance of the nose and face. This patient’s nostrils differed in flare width and vertical position, contributing to an uneven appearance on the basal (worm’s-eye) view.

Correcting nostril asymmetry within the same operation requires careful planning. Dr. Kang addresses the underlying cartilage architecture first, since tip and alar cartilage adjustments often resolve much of the visible asymmetry. Secondary alar base modification is then performed only if residual asymmetry remains, ensuring that corrections are proportionate and stable long-term.

Why Closed Rhinoplasty?

Dr. Chayoung Kang is a dedicated practitioner of closed (endonasal) rhinoplasty — a technique in which all incisions are made inside the nostrils, leaving absolutely no external scarring. While open rhinoplasty (which involves a small incision across the columella) is more common in many practices, closed rhinoplasty in expert hands offers compelling advantages:

• No visible scarring — incisions are entirely hidden inside the nose.
• Less postoperative swelling — the soft tissue envelope is disturbed less, so resolution is faster.
• Preserved blood supply — the nasal tip retains its natural circulation, reducing the risk of healing complications.
• Natural-feeling results — the connective tissue framework is kept largely intact, so the nose moves and feels natural after surgery.
• Faster recovery — patients typically return to daily activities sooner compared with open approaches.

Closed rhinoplasty demands a higher level of spatial reasoning and tactile skill from the surgeon, since visibility is more limited than in an open procedure. It is precisely this technical challenge that Dr. Kang has devoted her career to mastering — and why patients travel to Noselab specifically for this approach.

Surgical Planning: The Noselab Process

Before any surgery, Dr. Kang conducts a thorough consultation that goes well beyond surface-level aesthetics. The process includes:

1. Three-dimensional facial analysis — evaluating the nose in relation to the forehead, eyes, lips, and chin to understand what balance truly means for this individual face.
2. Structural assessment — palpating the nasal bones and cartilage to map the underlying framework, and reviewing any history of trauma or prior surgery.
3. Photographic documentation — standardised views (frontal, lateral, oblique, basal) are taken to support planning and to measure postoperative outcomes objectively.
4. Goal alignment — Dr. Kang discusses realistic outcomes with the patient, making clear that the aim is harmony and naturalness, not a “one-size-fits-all” nose.

For this patient, the surgical plan included: medial and lateral osteotomies to correct the bony deviation; septal cartilage work to straighten the mid-vault; tip suture techniques to rotate and refine the hanging tip; careful radix augmentation to define the glabella line; and alar base adjustment to address the remaining nostril asymmetry.

The Procedure in Detail

Step 1 — Osteotomy and Bony Vault Correction

To reposition the deviated nasal bones, Dr. Kang made precise osteotomy cuts using fine instruments introduced entirely through the nostrils. The bones were then carefully mobilised and repositioned into a straight alignment. Meticulous technique at this stage is essential — aggressive or imprecise osteotomies can lead to an irregular dorsum or prolonged bruising.

Step 2 — Septal Straightening

The nasal septum — the internal cartilage and bone that divides the two nasal passages — was found to contribute to the deviation. Septal cartilage was harvested, straightened, and repositioned. Importantly, harvested cartilage serves a dual purpose: it corrects the deviation and provides autologous (the patient’s own) material for tip grafting, eliminating the need for synthetic implants in this region.

Step 3 — Tip Rotation and Refinement

Using a combination of interdomal and transdomal sutures, Dr. Kang rotated the tip complex upward to correct the hanging appearance and improve the nasolabial angle. A columellar strut graft — fashioned from the harvested septal cartilage — was placed between the medial crura to provide structural support and maintain the corrected tip position long-term.

Step 4 — Glabella and Dorsal Line

A small, precisely shaped silicone implant was placed along the dorsum to augment the bridge and define the glabella line. Dr. Kang is particularly meticulous about implant selection and pocket creation: the implant must sit centrally, must not be too wide for the nasal bones, and must taper naturally into the defined radix superiorly and the supratip break inferiorly.

Step 5 — Alar Base Refinement

Following completion of the structural work, Dr. Kang assessed the nostrils from the basal view. Small, carefully placed alar base resection sutures were used to reduce flare on the more prominent side and to bring the nostril positions into closer symmetry. This final step required less intervention than initially anticipated — a common finding when the underlying cartilage framework is corrected first.

Recovery and Aftercare

Closed rhinoplasty recovery at Noselab typically follows this general timeline:

• Days 1–3: Mild swelling and bruising around the nose and under the eyes. A nasal splint is worn to protect and support the repositioned bones. Patients rest at home with the head elevated.
• Day 7: The splint is removed at the clinic. The majority of bruising has faded. The nose looks presentable in a social context, though it is still swollen.
• Weeks 2–4: Swelling continues to resolve. The tip remains somewhat firm as internal healing progresses.
• 3–6 months: The nose settles into its refined shape. Tip softness returns as scar tissue matures.
• 12 months: Final result is fully visible. For most patients, this is when photography for documentation is most meaningful.

Patients are given detailed aftercare instructions covering sleep position, activity restrictions, sun exposure, and follow-up appointments. Dr. Kang personally reviews each patient at key intervals to monitor healing.

Results

Following full recovery, the patient achieved the outcomes that had been planned:

• The nasal bridge runs straight on the frontal view, with the deviation fully corrected.
• The tip is naturally rotated upward, improving the nasolabial angle and creating a more youthful profile.
• The glabella line transitions smoothly into a defined, feminine dorsal line.
• The nostrils are balanced in both flare and vertical position, with no visible external scarring from the alar refinement.

Most importantly, the result looks like her — not like a template. The improvements are harmonious with her facial structure rather than superimposed upon it.

Is This Procedure Right for You?

This case illustrates that multiple nasal concerns can often be resolved in a single closed rhinoplasty session when carefully planned. Patients who may benefit from a similar approach include those with:

• A nose that appears crooked or off-centre from the front
• A tip that droops or hangs, particularly when smiling or at rest
• A flat or indistinct bridge-to-forehead transition
• One nostril that appears larger, flared, or positioned differently from the other
• A desire to avoid external scarring

The best way to know whether closed rhinoplasty can address your specific concerns is a direct consultation with Dr. Kang. Every nose is structurally unique, and a proper assessment is the foundation of a safe, satisfying outcome.