1. Nasal obstruction secondary to external/internal valve collapse, deviated septum and hypertrophic turbinates.

PROCEDURE:

1. Repair of nasal vestibular stenosis with reconstruction of external valve collapse with placement of bilateral lateral crural strut grafts.
2. Repair of nasal vestibular stenosis with reconstruction of tip support with placement of columellar strut.
3. Repair of nasal vestibular stenosis with reconstruction of internal valve collapse with placement of bilateral spreader grafts.
4. Repair of nasal vestibular stenosis with repositioning of lower lateral cartilage secondary to vertically-oriented positioning.
5. Right deep temporalis fascia harvest
6. Septoplasty.
7. Bilateral Turbinoplasty.
8. Open Primary Septorhinoplasty, platelet gel application.

FINDINGS: Native 9 mm lower lateral crura (LLC), concave (left greater than right) and cephalad oriented, external valve collapse with left greater than right, left alar retraction, narrow internal valve left greater than right, 3+ C – shaped septal deformity (convex to right) with 3+ left spur; right dome higher than left dome; wide caudal lateral nasal right bone; low and deep radix.

COMMENT: This patient wished to improve his profile and was having difficulty breathing. Post-operative photos reveal an improved nose. Better breathing has been reported as well.