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PREOPERATIVE DIAGNOSIS:
S/P Rhinoplasty X 4 with external nasal deformity with bilateral nasal obstruction secondary to left greater than right external valve collapse and internal valve collapse.
PROCEDURE:
Fifth Revision Rhinoplasty with rib graft and bilateral composite grafts.
Right Deep Temporalis fascia graft, platelet gel application.
FINDINGS: Tip encased with scar with small remnants of lateral crura present, Inverted V deformity following osteotomies, right middle vault narrower than left, wide left pyriform/lateral nasal wall despite multiple osteotomies, left greater than right external valve (weak alar); fibrosis/thick soft tissue at upper dorsum/radix skin with possibly hypertrophic procerus. Right greater than left alar retraction. Grafts placed: bilateral alar batten grafts, columellar strut, spreader grafts and combined infra-lobular onlay grafts, bilateral composite grafts.
COMMENTS: Her 14 month post-op results reveal an improved, more symmetric nose. The patient can also breathe better.
