Pinched Nose Corrective Rhinoplasty

Hello, this is Dr. Chayoung Kang, Director of Noselab Rhinoplasty Clinic. Today we will introduce the case of a corrective rhinoplasty for a patient with a small, deviated, upturned and pinched nose, presenting nostril asymmetry and other complex issues.

This patient suffered from nasal congestion and symptoms of rhinitis, and wanted to improve the wide appearance ofher glabella.

Preoperative Design Consultation

Small nose overall
Upturned nose and visible nostrils
Nasal deviation to one side
Pinched nose with prominent nostril asymmetry (the right side is more visible)
Wide glabella and nasal bridge

An overall unnatural appearance due to the upturned nose
Wide nasolabial angle

Unnaturally high starting point
Visible cartilage at the nose tip

Prominent nostril asymmetry
Columella deviated to the left causing the left nostril look small

Patient’s medical history

Year 2020: silicone + septal cartilage + functional surgery
Year 2022: silicone + donated rib cartilage + ear cartilage + osteotomy

Surgical Details

Taking into account the patient’s condition and needs, we established the following surgical plan:
a) Lowering the starting point of the nose bridge
b) Nasal congestion improvement
c) Straight nose shape without curves
d) Reducing the nasolabial angle
e) Septoplasty and submucosal resection of inferior turbinate (improves nasal obstruction)

Nasal endoscopy photo of the septal deviation to the right side

f) Septal reconstruction (depending on the degree of damage to the septal cartilage)
g) Reconstruction of the alar cartilage (depending on the degree of damage to the alar cartilage)and deviation correction
h) Nostril lowering surgery (correction of nostril asymmetry and nostril exposure)

The following surgeries were performed using a closed rhinoplasty approach:

a) Septoplasty and reconstruction:

Correction of the weakened and right side deviated septal correction
Septal reconstruction using autologous costal cartilage to reinforce the weak nasal septal cartilage.

b) Septal extension graft surgery:

Septal extension graft surgery to correct the deviation.

c) Nasal alar cartilage reconstruction:

Reconstruction of the alar cartilage that was barely existing. Improvement of the nasal deviation.

d) Nostril lowering surgery:

In particular, the right side lifted nostrils were corrected.

e) Dermal graft:

The dent was improved by grafting dermis onto the adhered area of the bridge of the nose.

f) Nose tipplasty:

The nose tip was cut and made into a sophisticated shape.

g) Nasolabial correction:

Reduction of the nasolabial angle to make the profile more natural-looking.

All procedures were performed using a closed approach, completing the surgery without external scars.

Before and After Surgery Photos

Frontal view before surgery (left) after surgery (right)

The upturned nose became more natural-looking as it was lowered, and the nostril exposure was also reduced.
Straightening of the deviated nose.
Improvement of the nostril asymmetry. Improvement of the right side pinched nostril.
The issue of the wide glabella was fixed through the appropriate adjustment of the width of the nose bridge.

Side profile view before surgery (left) after surgery (right)

The forehead line became more nature as the starting point became lower.
The overall profile improved as the nose tip became more natural-looking.
Adjustment of the nose bridge and tip height difference to give it a more three-dimensional appearance.

45-degree angle view before surgery (left) after surgery (right)

The nose became straighter as the strating point was lowered.
The characteristic upturned nose became natural and more sophisticated.

Nostrils before surgery (left) after surgery (right)

Great improvement of the nostril asymmetry.
Correction of the deviated columella.

After surgery table photos

Photos taken immediately after surgery, frontal view, 45-angle view, and side profile.

Overview

This is a case of solving complex problems at the same time as correcting a small, upturned, deviated, and pinched nose with nostril asymmetry. Since the patient’s nose was originally small, the surgery was performed without making it excessively high, and with an emphasis on overall balance and harmony.
We corrected the deviated nose and secured structural stability through septoplasty and reconstruction surgery. This is expected to have contributed significantly to not only cosmetic improvement but also improvement of nasal congestion and rhinitis symptoms. We resolved the problems of nostril asymmetry and excessive exposure through alar cartilage reconstruction and nostril lowering surgery. This can be said to be the area that brought about the greatest change to the frontal view.
Improving the bridge of the nose with dermal grafting played a significant role in smoothing the overall line of the nose. In addition, the nasolabial angle correction made the side profile more natural and harmonious. As a result, the upturned appearance and deviation improved, and the height difference between the
tip of the nose and the forehead was adjusted appropriately creating a three-dimensional effect. Overall, we were able to create a refined and natural nose shape.