PREOPERATIVE DIAGNOSIS: Nasal obstruction secondary to hypertrophic turbinates, external/internal valve collapse and s/p rhinoplasty.

Hypertrophic turbinates.

POSTOPERATIVE DIAGNOSIS: Same with nasal inlet obstruction secondary to twisted nasal bones.

PROCEDURE:

• Revision septal reconstruction (exploration) via open approach rhinoplasty.
• Repair of nasal left vestibular stenosis with reconstruction of external valve collapse with placement of left alar batten grafts.
• Repair of nasal vestibular stenosis with reconstruction of internal valve collapse with placement of left spreader graft.
• Graft, left ear cartilage and right composite grafts.
• Bilateral Turbinoplasty.
• Repair of nasal vestibular stenosis with reconstruction of right external valve collapse with placement of right composite graft.
• Repair of nasal vestibular stenosis with reconstruction of nasal inlet obstruction with bilateral osteotomies.

Secondary Rhinoplasty, platelet gel application.

FINDINGS: Narrow left middle vault, over-resectec left lateral crura, retracted right ala, over-rotated infratip lobule, left malar/maxillary deficiency causing deviation of nose and tip to left, complete depression left nasal bone and middle vault, columella and tip residually deviated to left at end of case.