Autologous Rib Revision Rhinoplasty and Nasolabial Angle Correction — The Judgment Process of a Case Where the Nose Looked Low and the Mouth Protruded
2024. 3. 15.
A case re-operated 5–6 years after autologous rib cartilage and silicone surgery because the height was unsatisfying. The judgment that a recessed nasolabial angle makes the mouth look protruding, forehead-line-based design, and the process of deciding on fresh autologous rib harvest plus alar base reduction together.
Key points
- If the mouth looks protruding without an actual protruding mouth, consider cases where the nasolabial angle (the angle between the tip and upper lip) is unusually recessed — then the nose also looks relatively less high.
- This case was re-operated because the desired height did not come out 5–6 years after autologous rib cartilage and silicone surgery, and the nose line was designed with the forehead line as the reference.
- The existing autologous rib cartilage amount was insufficient so it was freshly harvested, and the feeling of the nostril interior showing and spreading from the side was corrected together with alar base reduction.
There was a patient who had nose surgery with autologous rib cartilage and silicone 5–6 years ago. She had hoped for a glamorous, high line as much as possible with autologous rib cartilage, but after the first surgery it was not as high as expected — a low feeling — and unsatisfied, she returned to the clinic for revision.
This article organizes what was observed in this case and by what criteria the revision scope was decided.
01
Why did the mouth look protruding when it wasn't a protruding mouth?
If the nasolabial angle is deeply recessed, the area under the nose can sink and make the mouth look relatively forward — even without actual dental or jaw protrusion. In this case too, a low-looking nose and a deep nasolabial angle were observed together.
The reason it looked that way despite no protruding mouth was that the nasolabial angle was unusually recessed. When the angle between the tip and upper lip is recessed, it can be judged that relatively the nose looks less high and the mouth looks protruding.
In short, rather than only looking at "how much to raise the nose," the tip, upper lip, and profile proportions must be observed together to correctly pinpoint the cause of dissatisfaction.
02
What was the revision design based on?
This patient's forehead was quite high, and it could also be observed that the bridge and tip felt slightly lacking relative to the forehead line. Because she herself wanted to keep a smooth nose line continuing from the forehead, the design was done with the forehead as the reference.
The items checked and decided in this case are organized as follows.
| What was observed | Judgment / decision |
|---|---|
| Nasolabial angle unusually recessed | Judged as the cause of the mouth looking protruding and the nose looking less high — nasolabial angle correction included |
| High forehead with relatively lacking bridge and tip | Nose line designed with the forehead line as reference |
| Existing autologous rib cartilage amount insufficient for the target height | Autologous rib cartilage freshly harvested |
| Nostril interior visible and spreading look from the side | Corrected together with alar base reduction |
03
Why was autologous rib cartilage harvested again?
Autologous rib cartilage had also been harvested and used in the previous surgery, but because this patient wanted the nose higher, the previous amount was insufficient and it had to be freshly harvested.
In revision, like this, "how much usable material remains" becomes a premise of the design. What kind of material autologous rib cartilage is and in what cases it is considered can be seen in more detail in the autologous rib cartilage guide.
Additionally, alar base reduction was performed together, correcting the feeling of the nostril interior showing and the spread look from the side.
04
What changed after surgery?
In the postoperative appearance, the nasolabial angle was brought forward so the mouth looked recessed, and an effect of the jawline looking different could be observed. Also, once sufficient height from forehead to tip was secured, the surgery was finished with the whole profile's proportions relatively improved.
In summary, the key of this case is that the revision scope was decided not by nose height itself but by the proportions of the whole profile including nasolabial angle, forehead line, and nostril exposure. Other revision cases can be seen in the before-and-after photos.
05
Summary — a revision where proportion came before height
The answer for this case, where the height had been disappointing after the first surgery, was not simply "raising it more." Because the recessed nasolabial angle making the mouth look protruding, the nose line lacking relative to the high forehead, and the lateral nostril exposure were all observed together, the scope of fresh autologous rib harvest, nasolabial angle correction, and alar base reduction was decided. If you are considering revision, it is important to first distinguish what feels lacking in your current profile — along with the height you want.
Frequently asked questions
Answers to common questions patients ask before a consultation.
If the mouth looks protruding without a protruding mouth, can nose surgery change it?
If I had surgery with autologous rib cartilage before, can that cartilage be used in the revision too?
Why was alar base reduction done together?
Responses to treatment and recovery progress vary by individual. Outcomes and side effects vary from person to person. Bleeding, infection, swelling and asymmetry may occur. Please consult our medical team before making a decision.