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Preoperative Diagnosis:
- Nasal obstruction secondary to external/internal valve collapse, deviated septum and turbinate hypertrophy s/p rhinoplasty X 3.
- Residual deviated septum
- Turbinate hypertrophy
Procedure:
- Repair of nasal vestibular stenosis with reconstruction of external valve collapse with placement of bilateral alar batten 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 a right spreader grafts.
- Graft, right (X 2) and left ear carti lage composite grafts.
- Repair of nasal vestibular stenosis with reconstruction of external valve collapse with placement of bilateral composite grafts.
- Revision septoplasty.
- Bilateral turbinoplasty
Fourth Revison Rhinoplasty, platelet gel application.
Findings: Right greater than left internal/external valve collapse, narrow right lateral wall and wide left nasal bone, no lateral crural present (medial present), left alar retraction. Rib harvested right 5 (Dr. Swartout). Soft columella strut removed and reused as infratip lobule graft; over-resected sills right greater than left with bilateral composite grafts; previous incision chevron identified and W-incision placed in same region. In region of previous full-thickness cutaneous defect along the right ala, the dissection was tedious dissecting in this region and also on the left side due to the absence of lateral cartilage. 2+ polly beak scar was identified.
Comment: This is a patient who wished to have her nose corrected from previous unsuccessful surgeries (different physician). Post operative results reveal a softer looking and more functional nose.
