PREOPERATIVE DIAGNOSIS: : 1. Nasal obstruction secondary to external/internal valve collapse, deviated septum following rhinoplasty, 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. Graft, right and left ear cartilage conchal composite grafts.
5. Right deep temporalis fascia harvest secondary to thin skin.
6. Revision Septoplasty
7. Bilateral Turbinoplasty
8. Repair of nasal vestibular stenosis with reconstruction of rim collapse with retracted with placement of bilateral conchal composite grafts (skin & cartilage)

Secondary Rhinoplasty with rib harvest and reconstruction, platelet gel application

FINDINGS: Native 8 mm , concave on right; 10 mm on left lower lateral crura (LLC) weak, weak/ retracted rims. Narrow right greater than left middle vault, tip/cartilaginous dorsum deviated to right, over-projected tip and cartilaginous dorsum, Caudal septum deviated to right, most septum removed from previous surgery (approximately 6 mm at caudal septum and 4 6 mm at dorsal septum), vomer not removed secondary to scarred septal skin with no cartilage present and unilateral perf.

COMMENT: Costal (rib) cartilage was used for the reconstruction and a medial crural overlay of 3 mm was performed to deproject the over-projected nasal tip. The 14 month post-op photos reveal a smoother profile. The frontal view is more symmetric; however, nasal tip edema is still resolving.