[SURGICAL INSIGHT] Hump Nose and Facial Asymmetry Correction Case

Hello, this is ARC Plastic Surgery. Although many patients prefer to avoid surgery during the summer, I am sincerely grateful to those who continue to place their trust in our clinic. Today, I will present a recent case involving hump nose correction, combined with double eyelid asymmetry improvement and overall nasal alignment.

The patient was a medical student from Australia. As he was pursuing the same field of study, I felt a strong sense of responsibility to approach his case with the same care and precision I would offer a younger colleague. Patient’s Concerns Double eyelid asymmetry Hump nose Deviated nose Bulbous nasal tip

On examination, his overall facial asymmetry was immediately evident. The eyebrow height, eye corner angle, and double eyelid crease levels were different on each side, while the nasal bridge deviated markedly to the left. From the lateral profile, the nasal hump and slightly under-projected tip created a less refined appearance. While the skeletal foundation of the face cannot be altered, improving the eyelid crease balance and correcting the nasal bridge direction can significantly reduce asymmetry and enhance overall harmony. One notable point was the patient’s aesthetic preference: despite being male, he requested a relatively higher eyelid crease and a very natural nasal contour. In contrast, many Korean male patients often prefer lower creases and a more prominent nasal augmentation. This difference seemed to reflect cultural influence.

Surgical Plan Correction of double eyelid asymmetry (out-fold technique) Septal extension using rib cartilage for strong structural support Hump removal and correction of nasal deviation using osteotomy (medial and lateral) with implant placement Correction of deviated septum and crooked nose using the swing door technique Surgical Details For the eyelids, due to thin skin, a non-incisional double eyelid technique was selected. Each eyelid was fixed at five points. During fixation, it is critical to evert the eyelid and confirm that sutures are not exposed, as exposed sutures may cause corneal irritation, photophobia, or visual disturbance.

For bulbous tip correction, the SMAS layer and subcutaneous fat were removed from beneath the nasal tip skin. The SMAS is a well-known layer also addressed during facelifting procedures. Its careful removal reduces soft tissue thickness, producing a more defined tip. However, excessive dissection can damage microvasculature and increase the risk of necrosis or irregularity, thus meticulous handling is essential. Although the patient’s nasal bridge was relatively high, simple hump removal would have resulted in a widened appearance. Therefore, controlled osteotomies were performed, followed by implant placement to refine and narrow the bridge line.

Particular attention was given to the keystone area, where the nasal bones, septum, and upper lateral cartilages converge. Over-resection in this region can result in saddle nose deformity, so conservative and precise resection was performed. To correct the deviation, both bony and cartilaginous structures required alignment. A clocking suture was used to reposition the upper lateral cartilage, while the deviated septum was corrected using techniques such as scoring incision and swing door. This not only improved symmetry but also enhanced nasal airway function and tip stability.

Postoperative Outcome At 10 days postoperatively, the pronounced facial asymmetry had improved significantly. Matching the eyelid crease height alone provided marked balance, even in the presence of naturally uneven eyebrows and ocular shape. As the nose represents the centerline of the face, aligning the nasal bridge corrected the tilted impression observed preoperatively. The postoperative result showed a more stable, balanced, and aesthetically pleasing facial appearance, giving both the patient and observers a sense of harmony and comfort.