PREOPERATIVE DIAGNOSIS:

1. Nasal obstruction secondary to hypertrophic turbinates, residual deviated septum and external/internal valve collapse s/p rhinoplasty.

PROCEDURE:

1. Repair of nasal vestibular stenosis with reconstruction of external valve collapse with placement of bilateral alar batten and right rim 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. Right deep temporalis fascia harvest.
5. Bilateral Turbinate outfracture.
6. Revision Septoplasty.

Secondary Septorhinoplasty

FINDINGS: Thin dorsal skin; narrow lateral nasal walls, collapse external nasal valve with right greater than left due to concave native 9 mm lower lateral cartilages; narrow rims, cephalad rotated and retracted right ala; minimal anterior septum with slight saddling of cartilaginous dorsum, 3+ right bony septal spur identified abutting right lateral nasal wall; caudal septal deviation to left; bony septum present with minimal cartilaginous septum present; narrow right greater than left middle vault. Rib harvested by Dr. Wyatt.

COMMENT: This patient?s 4.5 month old post-surgery photos reveal a softer and natural profile. Patient continues to heal.