PREOPERATIVE DIAGNOSIS:

1. Nasal obstruction secondary to external/internal valve collapse, deviated septum following rhinoplasty, hypertrophic turbinates.

PROCEDURE:

1. Repair of nasal vestibular stenosis with reconstruction of external valve collapse with placement of bilateral rim grafts.
2. Repair of nasal vestibular stenosis with reconstruction of tip support/twisted columella with placement of columellar strut.
3. Repair of nasal vestibular stenosis with reconstruction of right internal valve collapse with placement of right double spreader grafts.
4. Right deep temporalis fascia harvest secondary to thin skin/depressed right lateral nasal wall.
5. Septoplasty.
6. Bilateral Turbinoplasty.

FINDINGS: Thin nasal skin, Weak rims (right greater than left). Narrow/collapsed right middle vault with depression of right lateral nasal wall and middle vault, significant 3+ caudal deviation to left with anterior dislocation to right, over-resected dorsum at rhinion, and twisted columella.

COMMENT: This patient wished to repair a deviated septum and soften nasal appearance. 7-month post operative photos reveal an improved nose.