Preoperative Diagnosis: Nasal obstruction secondary to external/internal valve collapse, residual deviated septum following rhinoplasty X 2.

Procedure: Tertiary Revision septorhinoplasty with placement of spreader grafts, lateral crural strut grafts, columellar strut, rim grafts, and harvest of ear and deep temporalis fascia. A conchal bullosa was also excised.

FINDINGS: Bilateral supra-alar batten grafts removed and used as columellar strut and spreader grafts. Ear cartilage used for rim and lateral crural strut grafts. Left lower lateral cartilage (LLC) remnant: 5 mm at widest dimension, Right LLC: 3 mm at widest dimension. Complete alar and rim collapse with right greater than left. Left alar retraction more than right. Narrow middle vault. Residual large left spur on floor and mid bony septum. Right conchal bullosa as per CT and exam.  

Comment: Her postop photos reveal an improved airway with residual nasal swelling.