PREOPERATIVE DIAGNOSIS: Nasal obstruction secondary to external/internal valve collapse, deviated septum following rhinoplasty X 2, hypertrophic turbinates.

PROCEDURE: Tertiary Revision Rhinoplasty with:

• Repair of nasal vestibular stenosis with reconstruction of external valve collapse with placement of bilateral rim grafts.
• Repair of nasal vestibular stenosis with reconstruction of external valve collapse with placement of bilateral alar batten grafts.
• Repair of nasal vestibular stenosis with reconstruction of tip support with placement of columellar strut.
• Repair of nasal vestibular stenosis with reconstruction of internal valve collapse with placement of bilateral spreader grafts.     
• Repair of nasal vestibular stenosis with reconstruction of nasal inlet obstruction from open roof deformity with revision osteotomies and release of the right rocker deformity.
• Graft, right ear cartilage
• Right deep temporalis fascia harvest.
• Revision Septoplasty
• Bilateral Turbinoplasty
• platelet gel application

FINDINGS: Absent lower lateral crura (LLC) (left more absent) with intermediate and medial crura present, soft tissue pollybeak identified and excised, Ear cartilage used for rim and alar batten grafts. Right rocker deformity present with open roof deformity. Complete alar and rim collapse with left greater than right. Bilateral Narrow left greater than right middle vault. Large left spur on floor and mid bony septum.  

Comment: The one year post-op photo reveals an improved nasal appearance.