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PREOPERATIVE DIAGNOSIS:
- Nasal obstruction secondary to external valve collapse, residual deviated septum, turbinate hypertrophy, twisted nasal bones causing nasal outlet obstruction following rhinoplasty.
- Residual deviated septum.
- Turbinate hypertrophy
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 bilateral osteotomies due to twisted nasal bones.
- Repair of nasal vestibular stenosis with reconstruction of bilateral external valve collapse with placement of bilateral rim grafts.
- Revision septoplasty.
- Bilateral turbinoplasty.
- Secondary septorhinoplasty, platelet gel application with Rib harvest.
FINDINGS: Thin skin scarred to nasal tip; convex left nasal bone, septum deviated to right with bony septum present and caudal deviation to right, right greater than left external valve collapse, asymmetric lateral nasal walls, deep radix/bony dorsum; soft tissue/scar/cartilage mass on tip from last rhinoplasty, right LLC (lower lateral cartilage) dome more caudally displaced than left; over-projected tip with long medial crura and over-rotated infratip lobule.
COMMENT: This patient wished to have a previous rhinoplasty revised (different surgeon). She was having trouble breathing, and desired a straighter and more symmetrical nose. 4 month photos reveal a softer nasal appearance, and her breathing has greatly improved. Patient continues to heal.
