This patient previously underwent closed rhinoplasty several years prior to presenting to my office for corrective nasal surgery. Specifically, this patient’s complaints involved the following:
1) Unattractive appearance of the nasal tip: She did not like the visibility of her nasal tip cartilages through her skin.
2) Retraction of the nostril rims: She did not like the appearance and position of her nostrils and felt that others could see up her nose in photographs.
3) Inability to breath through her nose: She related a history of progressive nasal airway obstruction since her last operation. The patient is quite athletic, and noted an inability to move air through her nose all the time. This was particularly troublesome during exercise.
1) Open approach, revision rhinoplasty. The correction of the internal airway and complex nasal tip reconstruction required an open approach via a transcolumellar incision.
2) Correction of alar malposition & nasal tip reconstruction. The orientation of the nasal tip cartilages was incorrect and resulted in a very unnatural tip appearance. Further, the cartilages had been asymmetrically trimmed and over-reduced during the primary operation. Reconstruction required alar extension grafts made from septal cartilage. The native weakness of the left ala required placement of a small PDS rhinoplasty plate.
3) Correction of alar retraction. The nostril rims were lowered by placement of composite ear cartilage grafts on both sides.
4) Correction of tip position. The nasal tip lacked support and had an unnatural orientation. This was corrected with placement of an angled columellar strut between the medial crura (tip cartilages).
5) Correction of nasal airway obstruction. The patient had internal valve collapse as a result of her primary operation. The was corrected by reconstructing the middle vault with placement of spreader grafts.
6) Correction of dorsal inclination and irregularities. The patient’s bridge was lowered, and the both visible and palpable bony irregularity was removed.
7) Correction of nasal skin scarring. The patient had an incredibly thin skin envelope that was scarred down to the underlying bones. This was corrected by placing a lining graft along the nasal bridge of deep temporal fascia.
*photos on this post are of an actual patient of Dr. Brenner.