PREOPERATIVE DIAGNOSIS:

1. Nasal obstruction secondary to external/internal valve collapse following rhinoplasty, residual deviated septum, and convextcolumella.

PROCEDURE:

1. Repair of nasal vestibular stenosis with reconstruction of external valve collapse with placement of bilateral lateral crural strutgrafts.
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. Repair of nasal vestibular stenosis with reconstruction of deviated columella secondary to convex/concave medial crura with placement of right medial crural batten graft.
5. Left deep temporalis fascia harvest.
6. Revision Septoplasty.

FINDINGS: Narrow bilateral external valve with right worse than left and divided dome with 3+ concavity; external valve collapse with left greater than right, medial crural right concave and left convex; caudal septum deviated to left with residual left spur, LLC approximately 6 mm in width.

COMMENT: Male patient who had trouble breathing and wanted to soften appearance of nose. I year post surgery photos demonstrate corrected septum and an improved profile.

Other procedures performed: Bilateral upper & lower (fat repositioning & transconjunctivalorbicularis excision) Blepharoplasty, chin implant, submental liposuction, platelet gel application.