PREOPERATIVE DIAGNOSIS:

1. Nasal obstruction secondary to deviated septum, turbinate hypertrophy, internal valve collapse and convex right nasal bones causing nasal inlet obstruction.
2. Turbinate Hypertrophy.
3. Septal Deviation.

PROCEDURE:

1. Submucous resection and partial resection of left turbinate and submucous resection and partial resection of right turbinate.
2. Complex septoplasty (closed approach) for correction of deviated nasal septum.
3. Repair of nasal vestibular stenosis secondary to bilateal external valve collapse with bilateral subcartilaginous and lateral crural strut grafts.
4. Repair of nasal inlet obstruction secondary to flat, convex right nasal bone.
5. Repair of nasal vestibular stenosis secondary to right internal valve collapse with placement of right triple-layered spreader grafts and left single spreader graft.
6. Right Deep Temporalis Fascia Graft Harvest.
7. Repair of nasal vestibular stenosis secondary to right and left external valve collapse with release and repositioning of right and left lower lateral cartilages.
8. Repair of nasal vestibular stenosis secondary to tip ptosis with placement a columellar strut.

Open SeptoRhinoplasty, Platelet gel application

FINDINGS: Collapsed external valve and left greater than right malpositioned lower lateral cartilages (LLC), Large septal spur to left and posterior right deviation with caudal septum deviated to left, narrow 3+ right greater than left middle vault, flat, convex right nasal bone, nasal tip deviated to left secondary to cephalad orientation of left lower lateral cartilage and pre-maxillary defiency (left), left LLC caudally displaced as compared to left, bilateral opposing septal tears secondary to 3+ spur with fascia and mucoperichondrium placed. Native lower lateral cartilages: 13 mm.

COMMENT: This is a patient who had trouble breathing and desired a softer nasal appearance.  15 month photos reveal an improved profile.

Bilateral (Upper and Lower) fat repositioning, and Blepharoplasty