Crooked Tip and Columella & Nostril Asymmetry Case Study 1

After rhinoplasty, it is surprisingly common for the tip and columella to become crooked and the nostrils asymmetric, accompanied by nasal obstruction.

Unhappy with how it looks and stressed every time they see it, patients go back to the clinic that performed the surgery,

only to be told, "The swelling has not fully gone down and things have not settled yet, so let's wait a little longer."

After waiting 2-3 months with still no improvement, quite a few of them then come to our clinic.

A crooked columella and tip and asymmetric nostrils after rhinoplasty are stressful enough, and patients are anxious and worried, unsure whether it will improve on its own with time or needs to be corrected.
However, this never improves on its own simply by waiting. Corrective surgery must be performed to regain the original appearance.

To correct this, the cause must first be identified with an endoscope and careful examination,

and then the twisted tip cartilages and septum must be returned to the midline.

Technically, there are two methods.

History: the 1st surgery was a simple augmentation rhinoplasty through a closed approach;

because the dorsum and tip became crooked as a result, the 2nd surgery, through an open approach, included a columellar strut,

a tip onlay graft, and dorsal augmentation.

The nostril asymmetry and the tilt of the columella were also

completely corrected by removal + closed simple repositioning alone.

The height of the bridge, which the patient had worried about, did not drop as much as expected and settled naturally,

and the patient, too, was pleased, saying the nose looks prettier after removal.

Before removal, the dorsum bulged as if there were a dorsal hump, but the dorsal line is now natural and attractive.

Before surgery, the tip cartilages were pressed by the silicone and the columella was bent,

but after surgery it straightened, and the tip is more projected.

The removed silicone, capsule, tip ear cartilage, and other material.

History: 7 years ago at another clinic, silicone + columellar strut + lengthening and a tip onlay graft with ear cartilage (open approach)

The patient said that 2 years ago the tip cartilage had become prominent and was trimmed (closed approach).

The tilted columella and asymmetric nostrils were diagnosed as resulting from misaligned suturing of the columellar strut

and from the derotation graft having been fixed tilted to one side when the nose was lengthened.

The cartilage protruding inside the right side of the nose was judged to be a protruding piece of

the derotation graft placed to lengthen the tip; nothing was visible inside the left side.

During surgery, we confirmed a columellar strut made of septal cartilage, a derotation graft made of ear cartilage,

We confirmed that an onlay graft and other grafts had been placed on the tip.

All of the implant and grafted cartilage were removed through an incision inside the nose alone (closed approach).

After removal and simple repositioning.

The columella is straight and the nostrils are symmetric.

After surgery, the nasal bridge was brought back to the midline, and the symmetry of the tip was restored.

The tip is well projected and has settled naturally.

With removal + closed simple repositioning alone, nostril symmetry improved,

and the crooked tip returned to the midline.

With removal + closed simple repositioning alone, the nasal axis returned to the midline,

and the tip became refined.

After the removal surgery, the tip is more projected and longer.

The dorsal line is natural, and the bridge did not drop as much as the patient had feared.