PREOPERATIVE DIAGNOSIS:

Nasal obstruction secondary to Internal/external valve collapse and turbinate hypertrophy.

PROCEDURE: Tertiary Revision External Rhinoplasty, Septoplasty and bilateral turbinoplasty.

1. Repair of nasal vestibular stenosis secondary to bilateral external valve collapse secondary to alar rim weakness with placement of bilateral rim grafts. 
2. Repair of nasal vestibular stenosis secondary to internal valve collapse secondary to right narrow/subluxed upper lateral cartilage with placement of right spreader grafts.
3. Revision Complex septal reconstruction, submucous resection with major partial vomerectomy for correction of deviated nasal septum.
4. Submucous resection and partial resection of right inferior turbinate.
5. Submucous resection and partial resection of left inferior turbinate.

Platelet gel; Tertiary revision rhinoplasty

FINDINGS: Right alar vertical onlay graft removed causing fullness in right alar region; asymmetric curved medial crura (right longer than left) with right higher dome; over-projected, over-rotated infratip lobule; narrow rims right greater than loft; soft tissue deficit right greater than left; narrow right middle vault and depressed right lateral nasal wall; spur and caudal deviation of septum to left; narrow lateral crura with scar tissue build up.

COMMENT: Patient still swollen in photos.  3 month post-op photos reveal softer nasal appearance.  Breathing has improved.  Patient still healing and will continue to improve.