Ear Cartilage Grafting and Nasolabial Angle Correction in Bulbous Rhinoplasty — How Far Do the Low Bridge and Sunken Columella Get Checked Together?
2025. 4. 15.
A case where a low bridge and bulbous nose were corrected without an implant using ear cartilage grafting — why the nasolabial angle and columellar depression are checked together, CT-based surgical planning items, and how nasolabial angle correction affects a protruding-mouth impression and philtrum length.
Key points
- When a low bridge and bulbous nose coexist, the surgical scope is set after checking the side-profile nasolabial angle (the angle between columella and philtrum) and columellar depression — not just the front view.
- This case corrected only the tip with septal and ear cartilage grafts, no implant, while also performing deviated septum correction, nasolabial angle correction, and downward advancement of the columella.
- Nasolabial angle correction can affect not just the tip but the impression of a protruding mouth and how long the philtrum looks — so design at the planning stage matters.
"My bridge is low and my tip is bulbous — can it be corrected without an implant?"
Among people looking into bulbous rhinoplasty, some are concerned not only about a blunt tip but also a low bridge, an upturned-looking tip, and a sunken columella. In these cases it's hard to plan surgery looking at just the tip. Only by checking the nasolabial angle and columellar state in profile can you tell where the whole line went unrefined.
Through a case of ear cartilage grafting and nasolabial angle correction in a patient who visited with a low bridge and bulbous nose, this article organizes what goes into the surgical plan and what's checked beforehand.
01
What condition did this case start from?
This patient visited with concerns about a low bridge and a bulbous nose.
In profile, the nasolabial angle — the angle between columella and philtrum — and the columella were depressed, so it wasn't just the tip: the whole line was unrefined. At first the nose also gave an upturned, short-looking impression.
After consultation, we decided to proceed with bulbous correction using ear cartilage grafting without an implant, and set the surgical plan after carefully reviewing CT. When implant-free rhinoplasty is possible is covered separately in the implant-free rhinoplasty guide.
02
What went into the surgical plan?
The surgical plan for this case was as follows.
- Septal and ear cartilage grafting — material to support and raise the tip without an implant
- Tip rhinoplasty — organizing the blunt tip shape
- Tip fat removal — organizing the soft tissue that makes up the bulbous volume
- Deviated septum correction — correcting the bent septum
- Nasolabial angle correction — correcting the angle between columella and philtrum
- Downward columellar advancement — moving the sunken columella downward and forward
Although it was a tip-only bulbous correction, we checked in advance the possibility of a step-off with the bridge once the tip was raised and designed in detail. Because the nose had looked upturned and short, the tip was planned to be raised with volume while being lowered ever so slightly downward.
03
Beyond the nose, what does nasolabial angle correction affect?
Nasolabial angle correction isn't only a matter of tip angle. In this case, nasolabial angle correction produced the effect of a mouth that had looked protruding appearing recessed.
Consulting with Japanese patients, a great many worry about nasolabial folds and philtrum length — and when the tip is pulled up, depressions around the alae or nasolabial folds are quite often relieved. If the area still bothers you after nose surgery, aristocrat surgery (paranasal augmentation) with an additional implant can also be introduced.
For the philtrum, adjusting the tip angle can make it look shorter from the front. That's why receiving a surgical plan and design that considers even this area's impression matters.
| Area checked | What's examined | Response in this case |
|---|---|---|
| Tip | Bulbous volume and support state | Septal/ear cartilage grafting, tip fat removal |
| Columella & nasolabial angle | Depression, angle with philtrum | Nasolabial angle correction, downward columellar advancement |
| Bridge | Possibility of a step-off after tip elevation | Checked in advance at the design stage |
| Septum | Whether it's bent | Deviated septum correction performed together |
After surgery the tip was set and its shape organized, changing from a heavy, short-looking impression to a line with visible contour. Actual before-and-after changes can be seen in the before-and-after photos.
04
Summary — not just the tip, but the side-profile angle too
When a low bridge and bulbous nose coexist, surgery is hard to set by tip shape alone. In this case, because the side-profile nasolabial angle and columellar depression were checked together, a plan that added nasolabial angle correction and downward columellar advancement to tip correction could emerge. Design that foresees postoperative changes — like the bridge step-off that can occur as the tip rises — also happens at the planning stage.
If you're curious how far your own nose needs to be checked, it can be confirmed based on your current state in a 1:1 video consultation.
Frequently asked questions
Answers to common questions patients ask before a consultation.
When a low bridge and bulbous nose coexist, is implant-free surgery possible?
Does nasolabial angle correction change how the mouth looks?
Does raising the tip also change nasolabial folds or the philtrum?
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.