Revision Rhinoplasty #32

This is an example of an early post-operative appearance, 5 months following a complex, functional and cosmetic revision rhinoplasty surgery. Our patient was dissatisfied with the appearance of her nose after previous rhinoplasty, and she also sustained nasal trauma which led to a more crooked nasal appearance, and nasal obstruction on both sides.

From a functional standpoint, when I explored her, she had mostly all of her lower lateral cartilages completely removed by her previous surgeon. This was causing severe external nasal valvular collapse, when she would breathe in. Additionally, you can see irregular points of cartilage involving her nasal tip and these are called bossae. She also had an open roof deformity, an inverted V deformity, and a crooked nasal tip appearance, due to a severely deviated nasal septum. There was also an exaggerated curvature from her colimella to her tip which led to an overrotated nasal tip appearance - all stigmata of previous surgery. Fortunately, her previous surgeon never performed septoplasty, so there was a plethora of her own cartilage for me to reconstruct her nose.

Goals were to reconstruct her nasal airway, and to provide a less distracting, and less operated looking nasal appearance. Her internal nasal valves were repaired with spreader grafts on both sides. Her external nasal valve collapse was repaired with lateral crural strut grafts. We achieved a straighter nasal base appearance by correcting her severely deviated nasal septum, and by using a columella shoring strut graft.

After surgery, you can see a more natural looking nasal appearance that doesn't call attention to itself, and we are all grateful that her nasal airway is reconstructed, and she is breathing perfectly. I am beyond grateful that she has allowed us to post her photos.