Correcting an Upturned and Bulbous Nose with Closed Rhinoplasty

An upturned nose—characterized by an excessively rotated nasal tip and a short columella—combined with a bulbous, undefined tip is one of the most nuanced challenges in aesthetic rhinoplasty. At Noselab Plastic Surgery Clinic, Dr. Chayoung Kang approaches each case with meticulous surgical planning and a deep commitment to natural-looking results. This case study walks through how closed rhinoplasty was used to address both concerns simultaneously, without a single external incision.

Understanding the Patient’s Concerns

The patient presented with two interrelated concerns that are frequently seen together in rhinoplasty consultations:

• Upturned nasal tip (Overrotated tip): The tip of the nose pointed excessively upward, exposing the nostrils from a frontal view and creating an imbalanced facial profile.
• Bulbous nasal tip: The lower lateral cartilages were wide-set and poorly defined, giving the tip a round, undefined appearance that lacked refinement.

Together, these features created a nose that appeared short, infantile, and disproportionate to the patient’s other facial features. The goal was to lengthen the nose, reduce tip rotation, and define the tip—all while preserving the nose’s natural character and ethnic harmony.

Why Closed Rhinoplasty Was the Right Choice

Dr. Kang is one of Korea’s leading specialists in closed rhinoplasty—a technique in which all incisions are made entirely inside the nostrils. This approach offers several key advantages:

• No visible scarring: Because there is no external columellar incision, patients heal without any surface marks.
• Reduced swelling and faster recovery: Closed rhinoplasty causes less tissue disruption, leading to quicker resolution of post-operative swelling.
• Preserved structural integrity: By avoiding wide soft tissue elevation, the natural support of the nasal tip is better maintained.
• Precise, controlled correction: In experienced hands, the closed approach allows for highly refined tip work—cartilage reshaping, repositioning, and grafting—all through endonasal access.

The closed technique demands a higher level of surgical skill and spatial awareness than open rhinoplasty. Dr. Kang’s extensive experience with this method allows her to achieve predictable, symmetrical outcomes without relying on the broader exposure of an open approach.

Surgical Plan: Derotation and Tip Refinement

After a thorough consultation and three-dimensional imaging analysis, Dr. Kang designed a surgical plan targeting the two primary concerns:

1. Correcting the Upturned Tip (Tip Derotation)

To counteract excessive tip rotation, Dr. Kang employed a caudal septal extension graft. This technique uses a piece of cartilage (typically harvested from the nasal septum) to extend the caudal edge of the septum downward and forward. By anchoring the tip cartilages to this extended platform, the tip is repositioned at a more natural angle—lengthening the nose and reducing nostril show from the front.

The nasolabial angle, which was acutely above the ideal range, was brought to a more harmonious position, improving both the lateral profile and the frontal silhouette.

2. Defining the Bulbous Tip

The bulbous appearance was addressed through a combination of cartilage scoring, dome binding sutures, and a columellar strut graft. By narrowing the domes of the lower lateral cartilages and improving their projection and symmetry, the tip gained a refined, sculpted look without appearing over-operated or pinched.

All cartilage work was performed through endonasal access—no external incisions were required. The use of the patient’s own septal cartilage as the grafting material also ensures long-term biocompatibility and natural feel.

Recovery Timeline

Closed rhinoplasty patients at Noselab typically experience the following recovery progression:

• Day 1–3: Mild to moderate swelling and bruising around the nose and under the eyes. A nasal splint is worn to support the new tip position.
• Day 7–10: Splint removal. Most patients feel comfortable returning to daily activities. Residual swelling is present but concealed naturally.
• Week 3–4: The majority of visible swelling has resolved. The new tip shape becomes clearly apparent.
• Month 3–6: Final settling of tip cartilages. The full refinement of the nasal tip is visible.
• Month 12: Complete final result. Cartilage has fully integrated and soft tissue has remodeled to the new architecture.

Results: A Natural, Balanced Profile

The post-operative photographs demonstrate a meaningful transformation. The nasal tip has been successfully derotated to a more downward-pointing position, reducing nostril exposure and lengthening the visible nose. The tip itself is noticeably more defined and refined, with a clear central highlight and a smoother transition from the dorsum.

Critically, the result looks entirely natural. The nose is not over-corrected or artificial in appearance. It harmonizes with the patient’s facial structure and enhances the overall facial balance without announcing itself as surgical.

This is the hallmark of Dr. Kang’s philosophy: rhinoplasty should improve, not replace. The goal is always a nose that looks like it was always meant to be there.

Is Closed Rhinoplasty Right for You?

Closed rhinoplasty for upturned and bulbous nose correction is appropriate for a wide range of patients, but the ideal candidate typically:

• Has good nasal cartilage quality and adequate septal tissue for grafting
• Does not require major bony dorsal reduction (which may be better suited to open access)
• Prioritizes minimal scarring and a faster recovery
• Is realistic about the gradual nature of the healing process

The best way to determine candidacy is through an in-person consultation. Dr. Kang evaluates each patient’s anatomy individually and recommends the approach—open or closed—that is most likely to achieve the desired result safely and effectively.

About Noselab Plastic Surgery Clinic

Noselab Plastic Surgery is a Seoul-based clinic specializing exclusively in rhinoplasty. Founded and led by Dr. Chayoung Kang (강차영), Noselab has built a reputation for natural-looking results achieved through the most refined closed rhinoplasty techniques available.

Dr. Kang’s approach prioritizes long-term structural stability, ethnic harmony, and a result that feels authentic to each patient’s face. Her meticulous attention to cartilage architecture and soft-tissue dynamics sets Noselab apart as a destination for patients who want expertise without compromise.

• Specialty: Closed Rhinoplasty (Primary & Revision)
• Lead Surgeon: Dr. Chayoung Kang
• Location: Seoul, South Korea
• Website: noselabu.duckdns.org
• Consultation: Available in Korean and English

All surgical results are individual and may vary. Photographs are used with patient consent. This content is for informational purposes only and does not constitute medical advice.