RIGHT-AFTER CASE BRIEFING
Bulbous, low, upturned and short nose corrected with autologous rib cartilage — immediately after rhinoplasty
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.
These KOWON Plastic Surgery rhinoplasty before-and-after photos, taken right after surgery, show the actual direction of change in a nose that was low, short and upturned, after surgery with autologous rib cartilage and RIBFIT™ (diced autologous rib cartilage).
Hello, this is Dr. Kim Hyung-taek of KOWON Plastic Surgery.
What this patient wanted at consultation was clear: to correct an upturned nose — an “up-nose” — and to bring down, just slightly, the sense that it looked short. The patient asked whether the alae, which looked droopy, could improve at the same time, and wanted the tip left round rather than pointed. Silicone would have been acceptable for the bridge, but the patient wanted to hear about autologous rib cartilage before deciding.
Seen from the side, the tip pointed upward so the nostrils showed, and the nose was short, which made the philtrum look long. The bridge was low, so the profile looked flat, and the tip was spread, giving an overall childlike, cramped look.
Why do an upturned nose and a short nose need to be corrected together?
In most cases an upturned nose and a short nose share the same cause. When the cartilage that supports the tip is short and weak, the tip cannot extend forward and curls upward instead. Raise only the bridge in this state and the tip stays upturned, leaving an awkward nose in which the bridge and tip don’t belong together. So the first step is to bring the tip sufficiently forward and down to create length, and the bridge height is then set to match that length.
Why did I recommend autologous rib cartilage?
Bringing the tip down this far needs ample cartilage to support it. For this patient, septal cartilage alone was not enough to bring the tip down as far as wanted, and forcing it could have let the tip turn up again little by little over time. So I recommended the patient’s own rib cartilage — autologous rib cartilage. I explained that because it is the body’s own cartilage there is less concern about inflammation or a foreign-body reaction, and that its strength helps a lowered tip hold its position over time; the patient decided to go this way.
Silicone was also an option for the bridge, but since the tip was being done with rib cartilage, I raised the bridge with RIBFIT™ (diced autologous rib cartilage), made by finely dicing the same rib cartilage. RIBFIT™ settles softly under the skin of the bridge, so it is less likely to show an outline or shift the way an implant can, and over time it tends to blend in naturally, like the patient’s own nose. Silicone is not a bad material, but in more than 20 years of rhinoplasty I have found that, for patients having rib cartilage, matching the bridge with the same material has given more stable results.
How this patient’s surgery was done
First, I used autologous rib cartilage to bring the tip forward and down, creating length. Because the patient wanted it brought down “just a little”, I didn’t push for length and stopped where the proportion with the philtrum looked natural. As the tip came down, the upward-facing nostrils were no longer visible from the side, and the drooping alae the patient had worried about were tidied as well, as the heights of the tip and alae were brought into line.
For the spread, bulbous tip, I brought the splayed cartilages together with tip-cartilage suturing and trimmed the soft tissue of the tip. In line with the request not to make it pointed, though, I shaped the very end of the tip so that a rounded feel remained. A sharp tip is not automatically a pretty one; for a soft face shape like this patient’s, a tip finished round tends to suit the face better.
I also did a hanging-columella correction at the tip. When the tip is brought down, the columella — the central pillar of the nose — can appear to hang below the nostrils, so I dealt with this in advance to keep the nostril line clean from the side. Without this step, it is easy to end up with a longer nose but nostrils that look stretched.
The bridge was raised with RIBFIT™, lined up so that it flows in a single line from the glabella to the tip without standing out above the tip.
In the photo taken right after surgery, you can see that the tip that pointed upward has come forward and down, and the low bridge has risen, so the flow of the profile is tidier. This is why the philtrum looks shorter and the face looks more three-dimensional even though the nose was lengthened only a little.
[OP PLAN]
- Diagnosis: bulbous nose + low bridge + upturned nose (up-nose) + short nose, with drooping alae
- Patient’s requests: correct the upturned nose, lengthen the nose only slightly, keep the tip round (not pointed), improve the drooping alae
- Tip: tip extension with autologous rib cartilage – brought forward and down to gain length and correct the upturned tip
- Bulbous tip: tip-cartilage suturing + tip soft-tissue trimming (keeping a rounded tip)
- Columella: hanging-columella correction – tidying the columella that can look droopy once the tip is lowered
- Bridge: RIBFIT™ (diced autologous rib cartilage) – matched to the tip height, one line from the glabella to the tip
- Approach: open rhinoplasty (open incision)
See this patient’s before-and-after photos 6 days after surgery
Right after surgery is the stage before the swelling really builds, so the bridge and tip lines and the change in nose length created by the rhinoplasty can be seen relatively clearly.
KOWON Plastic Surgery starts from natural-looking change, but aims beyond a result that simply doesn’t show — for a “natural-glam” rhinoplasty that brings out the flow of the line and its details.
As recovery goes on, the swelling subsides and the tissues settle, and the tip takes on a softer, more natural shape than it has now. The chest area where the rib cartilage was harvested is left with a small incision mark, which fades over time and does not interfere with daily life. Rhinoplasty results can differ with each person’s skin thickness and cartilage, and the settled final result can be seen after a sufficient recovery period.