Hispanic female patient desiring a more natural appearing nose following a previous rhinoplasty performed elsewhere.

Procedure: Revision Septorhinoplasty with harvest of left ear cartilage and left deep temporalis fascia graft.

Findings: Over-resected lower lateral cartilage with minimal to no cartilage present lateral to the dome with left bossa formation, minimal to no tip support with buckling of medial crura, minimal caudal septal strut left in place with buckling of septum obstructing the left airway and left deviated bony septum with spur. Bilateral turbinate hypertrophy. Shield graft identified and removed.

Grafts from ear cartilage included: Bilateral alar batten grafts, septal batten grafts and a columellar strut. Deep temporalis fascia was placed over the tip upon completion.

Comments: The 2 month postoperative photos demonstrate a more symmetric, softer nose with residual tip swelling that will resolve.