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Female patient unhappy with her nasal tip and left middle vault. She has had approximately 8 rhinoplasties and had goretex placed over her left middle vault.
Procedure: Revision septoplasty, Revision Rhinoplasty (9th), ear cartilage graft, deep temporalis fascia graft, and platelet gel application.
Findings: After removal of left goretex, Narrow/collapsed left middle vault with internal valve compromise and sidewall, over-resected lower lateral cartilage (intermediate and medial crural present with 4 mm lateral components with external valve collapse, large left septal spur, right alar retraction, over-rotated tip, poor tip support & loss of projection.
Intra-operative procedures included removal of goretex, placement of left spreader grafts, alar batten grafts, columellar strut and fascia over tip.
Comment: Her 1 year photos reveal a softer, more elegant nasal tip and middle vault.
