PREOPERATIVE DIAGNOSIS:

Nasal obstruction secondary to malpositioned/over-resected lower lateral cartilages (external valve collapse)/Internal valve collapse, turbinate hypertrophy and deviated septum.

Septal Deviation.

Bilateral turbinate hypertrophy.

PROCEDURE: External Rhinoplasty

1. Repair of nasal vestibular stenosis secondary to bilateral external valve collapse secondary to alar rim collapse and malpositioned lower lateral crura with placement of bilateral lateral crural strut grafts.
2. Repair of nasal vestibular stenosis secondary to internal valve collapse secondary to narrow/subluxed upper lateral cartilage with placement of bilateral spreader grafts (double on left).
3. 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
6. Repair of nasal vestibular stenosis secondary to nasal tip ptosis with placement of a columellar strut.
7. Repair of nasal vestibular stenosis secondary to deviated nasal pyramid causing nasal inlet obstruction with ostoeotomies.

FINDINGS: Weak alar rims secondary to malpositioned lower lateral cartilage causing collapse, left deviated septum with spur with caudal deviation to left & narrow middle vault (left greater than right), and nasal tip ptosis.

COMMENT: This patient was having trouble breathing and wished to improve her profile. Post-surgery photos reveal a softer nasal appearance.