Patient 198

PREOPERATIVE DIAGNOSIS:

1. Nasal obstruction secondary to external/internal valve collapse, residual deviated septum, hypertrophic turbinates following rhinoplasty X 2.
2. Residual Deviated septum.
3. Bilateral hypertrophic turbinates.

PROCEDURE:
Revision Tertiary Septorhinoplasty with rib harvest

1. Repair of nasal vestibular stenosis with reconstruction of external valve collapse with placement of bilateral lateral crural strut grafts.
2. Repair of nasal vestibular stenosis with reconstruction of bilateral rim external valve collapse with placement of bilateral rim grafts.
3. Repair of nasal vestibular stenosis with reconstruction of internal valve collapse with placement of bilateral extended spreader grafts.
4. Repair of nasal vestibular stenosis with reconstruction of weak tip with placement of a columellar strut.
5. Revision Septoplasty with reconstruction of L-strut.
6. Bilateral inferior turbinoplasty.
7. Repair of nasal vestibular stenosis due to malpositioned lower lateral cartilages with repositioning of cartilages
8. Bilateral Diagnostic Nasal Endoscopy.

FINDINGS:
Retracted right greater than left  rims, polypoidal changes of right inferior turbinate, extensive conchal cartilage dorsal augmentation, columellar strut (thick) and tip graft removed; Grafts harvested from rib, narrow middle vault, bony septum and spur to left with only a cephalad 1 cm in length X 5 mm deep cartilage intact (no L-strut),  absent right lower lateral cartilage, partial left medial crura intact, 3mm X 3 mm region of atrophic skin in region of left soft tissue triangle and lower lateral cartilages which were concave and asymmetric.

COMMENT:
This patient was having trouble breathing and wished to improve the appearance of their nose, and correct the results of two unsuccessful previous rhinoplasties (different surgeon). Post-operative reveal a softer profile. Patient has reported improved breathing as well. Patient continues to heal.

Beverly Hills Rhinoplasty