1. Nasal obstruction secondary to external/internal valve collapse, deviated septum and turbinate hypertrophy s/p rhinoplasty X 3.
2. Residual deviated septum
3. Turbinate hypertrophy

Procedure:

1. Repair of nasal vestibular stenosis with reconstruction of external valve collapse with placement of bilateral alar batten 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 a right spreader grafts.
4. Graft, right (X 2) and left ear carti lage composite grafts.
5. Repair of nasal vestibular stenosis with reconstruction of external valve collapse with placement of bilateral composite grafts.
6. Revision septoplasty.
7. Bilateral turbinoplasty

Fourth Revison Rhinoplasty, platelet gel application.

Findings: Right greater than left internal/external valve collapse, narrow right lateral wall and wide left nasal bone, no lateral crural present (medial present), left alar retraction. Rib harvested right 5 (Dr. Swartout). Soft columella strut removed and reused as infratip lobule graft; over-resected sills right greater than left with bilateral composite grafts; previous incision chevron identified and W-incision placed in same region. In region of previous full-thickness cutaneous defect along the right ala, the dissection was tedious dissecting in this region and also on the left side due to the absence of lateral cartilage. 2+ polly beak scar was identified.

Comment: This is a patient who wished to have her nose corrected from previous unsuccessful surgeries (different physician). Post operative results reveal a softer looking and more functional nose.