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PREOPERATIVE DIAGNOSIS: : 1. Nasal obstruction secondary to external/internal valve collapse, deviated septum following rhinoplasty, hypertrophic turbinates.
PROCEDURE:
- Repair of nasal vestibular stenosis with reconstruction of external valve collapse with placement of bilateral lateral crural strut grafts.
- Repair of nasal vestibular stenosis with reconstruction of tip support with placement of columellar strut.
- Repair of nasal vestibular stenosis with reconstruction of internal valve collapse with placement of bilateral spreader grafts.
- Graft, right and left ear cartilage conchal composite grafts.
- Right deep temporalis fascia harvest secondary to thin skin.
- Revision Septoplasty
- Bilateral Turbinoplasty
- Repair of nasal vestibular stenosis with reconstruction of rim collapse with retracted with placement of bilateral conchal composite grafts (skin & cartilage)
Secondary Rhinoplasty with rib harvest and reconstruction, platelet gel application
FINDINGS: Native 8 mm , concave on right; 10 mm on left lower lateral crura (LLC) weak, weak/ retracted rims. Narrow right greater than left middle vault, tip/cartilaginous dorsum deviated to right, over-projected tip and cartilaginous dorsum, Caudal septum deviated to right, most septum removed from previous surgery (approximately 6 mm at caudal septum and 4 6 mm at dorsal septum), vomer not removed secondary to scarred septal skin with no cartilage present and unilateral perf.
COMMENT: Costal (rib) cartilage was used for the reconstruction and a medial crural overlay of 3 mm was performed to deproject the over-projected nasal tip. The 14 month post-op photos reveal a smoother profile. The frontal view is more symmetric; however, nasal tip edema is still resolving.
