Preoperative Diagnosis:

1. Nasal obstruction secondary to deviated septum, hypertrophic turbinates, and external/internal valve collapse, s/p rhinoplasty
2. Deviated septum
3. Hypertrophic turbinates
4. Submental lipodystrophy

 Procedure:   

1. Septal reconstruction for correction of deviated nasal septum and harvest of septal graft
2. Repair of nasal vestibular stenosis with reconstruction of external valve collapse with placement of bilateral alar rim grafts
3. Repair of nasal vestibular stenosis with reconstruction of tip support with placement of columellar strut
4. Repair of nasal vestibular stenosis with reconstruction of internal valve collapse with placement of bilateral spreader grafts
5. Bilateral Turbinoplasty
6. Repair of nasal vestibular stenosis with reconstruction of right external valve collapse with placement of right alar batten graft
7. Repair of nasal inlet obstruction secondary to open roof deformity with bilateral osteotomies
8. Secondary rhinoplasty with dorsal augmentation
9. Submental liposuction

Findings:          
Lower lateral cartilages (LLC) encased in scar/fibrous tissue, narrow right greater than left middle vault, poor tip support, right external valve collapse, over-resected mid-dorsum, septum deviated to left also at caudal aspect, open roof deformity, Tip: right dome higher than left, depression right mid lateral nasal wall and cephalad left lateral nasal wall, soft tissue pollybeak deformity.

Comment: 
This patient wished to correct a deviated septum, improve nasal appearance, and reduce fat under the chin. 7-month post-operative photos reveal an overall improved profile. Patient has reported better breathing as well.

Liposuction Patient