A 13 1/2 year follow-up on a woman who was bothered by the appearance of her nose. This was before computer simulation and I have sketched out the changes that we wanted to make in a side view. She had deviation of the septum a marked collapse of the internal nasal valve ( a Breath rite strip is used to temporarily improve this sometimes). She is shown before and again, 13 1/2 years after an open rhinoplasty with bilateral spreader graft placement as well as placement of a columnellar support strut from the septum to stabilize her nasal tip. Her nose is no longer blocked and she loves the natural appearance of her nose after surgery. The dorsum is straight and the tip is refined in appearance.
A woman in her mid 40’s who is bothered by drooping of the nasal tip and a dorsal hump. The tip is also bulbous in appearance. She snores and wakes up with a dry mouth in the morning. On exam she has a positive “Cottle” maneuver bilaterally demonstrated collapse at the internal nasal valve ( the area that is improved with “breath rite strips”) as well as septal deviation. She is shown before and again, 2 ½ years after an open rhinoplasty with septoplasty and correction of the vestibular stenosis with bilateral spreader graft placement. Her nasal obstruction has resolved, and she is pleased with the natural appearing improvement of her nose.
A woman in her late 40’s who was bothered by a “bump” on her left mid nose. She first noticed this after being struck by a ball in the nose a few years before. On examination she has very thin skin and has a prominent cartilage bump under the skin. A surgical rhinoplasty is an option to reshape the cartilages and add a strip of fascia from her scalp under the skin to add more thickness and help to camouflage this area. I recommended that she might try a “non surgical rhinoplasty” first with the use of Restylane injected under the skin to camouflage the area. This was done in a few minutes in the office with a topical anesthetic. She is shown 2 weeks after and has a significant improvement with ½ cc of Restylane. Although this is not permanent, it typically lasts for a year or longer in this area and is easy to repeat. She is pleased with her improvement. The nose looks straighter, and the “bump” is no longer as noticeable. The side view shows an improvement in the dorsum.
A 20 yo woman who does not like her nasal profile. She also has severe nasal obstruction and before her surgery would snore at night and wake up with a dry mouth in the morning. She had a positive Cottle maneuver bilaterally which is a test for collapse of the nose at the internal nasal valve. She also has significant deviation of the septum. She is shown before and again, just 6 weeks after an open aesthetic rhinoplasty combined with a septoplasty and bilateral spreader graft placement. Although it has been just 6 weeks since her surgery, her nasal obstruction has resolved. And she is thrilled with her new nose and no longer tries to hide her profile. The nasal tip should continue to gain in refinement over the next 3 years as the swelling in the nasal tip continues to decrease.
A woman in her early 20’s who was interested in chin augmentation and rhinoplasty. She did not like the overall shape of her nose and the dorsal hump, and also feels that her chin is too small for her face. She also had a history of nasal obstruction and would snore at night and wake up with a dry mouth in the morning. She is shown before and again, 6 weeks after an open rhinoplasty with straightening of her septum and placement of spreader grafts to correct collapse of the internal nasal valve. She had a solid silicone anatomic chin implant placed through an incision under the chin at the same time. Her nasal obstruction is improved, and she is thrilled with her natural appearing improvement. The nose looks better already at the 6 week mark but will typically continue to improve in the tip area over the next 3 years as swelling gradually resolves.
An early ( 6 week) result on a woman in her late 30’s who was bothered by the appearance of her nose as well as by difficulty breathing. She had a severely deviated septum as well as obstruction of the “internal valve” of the nose ( the kind of obstruction that is improved with BreathRite strips) Because of this obstruction she would snore at night and wake up with a dry mouth in the morning. She also felt that her nose was too large for her face and was crooked.
She is shown before and again, 6 weeks after an open rhinoplasty with septoplasty and bilateral spreader graft placement. Her chin is slightly “weak” and her facial balance could be improved further with a chin implant but she elected not to have this done at this time.
The postoperative photos show that the nose is much straighter in appearance and the tip has more refinement. The tip shape will typically continue to improve over the next 3 years as the swelling slowly resolves. She is already thrilled with her early result, and her breathing is dramatically better.
Update: Our patient is seen again at 6 months after her surgery. The nose continues to gain in definition and refinement as the swelling after surgery continues to diminish. This will typically continue for about 3 years after surgery.
following a nasal fracture playing basketball in high school. Although his fracture was apparently reduced at the time he had almost complete obstruction of both sides of his nose, with his nasal septum collapsed like a accordion. He is shown before and again, 6 weeks after an extracorporeal septoplasty/open rhinoplasty. In a case like this the septum is removed completely, straightened on the surgical table and attached to a pds plate ( a dissolvable plastic like material) to stabilized it and then placed back into the nose. Spreader grafts were placed at the same time. He is shown 6 weeks after surgery and not only is he able to breath normally again, but his nose is much straighter.
Update: Our patient is now seen 8 months after his surgery. His nasal obstruction has resolved and his nose has maintained its shape after his extracorporeal septal reconstruction
A 16 year followup on a woman after an open rhinoplasty and chin augmentation using a silicone Flower’s mandibular glove implant. She had her original surgery in her 20’s. She remains thrilled with her dramatic and yet still natural improvement.
A student in her late teens who was referred by her ENT because of severe nasal obstruction. She was struck with a dodgeball in the nose a year early, and had had significant trouble breathing through her nose ever since. She snored at night and would wake up with a dry mouth in the morning, She is shown 8 weeks after a reconstructive rhinoplasty with correction of her deviated septum and bilateral spreader graft placement. ( like a “breath rite” strip inside the nose). We improved her small dorsal hump and bulbous tip at the same time. The nose appears much straighter and in better balance. The tip definition will typically continue to improve for 3 years after surgery. She is already thrilled with her early result and able to breathe through her nose now.
A 10 year followup on a secondary rhinoplasty. Our patient had initially had a rhinoplasty in California 16 years before and did well until her young infant accidently “head-butted” her in the nose and it collapsed, making it difficult for her to breath. There was a technique called the “Goldman tip” where the cartilages were cut through to give more definition of the tip. Unfortunately, this tends to weaken the nose and was prone to pinching of the tip and collapse, as we have seen here. In my training at the University of Michigan we were taught to strengthen the nose, added grafts were needed and performing “non-destructive” tip rhinoplasty, where the structure of the nose is strengthened and not weakened at the time of surgery. He nose had collapsed inside and she needed an open rhinoplasty with placement of cartilage grafts harvested from the septum to rebuild the lower alar cartilages, as well as to hold open the upper lateral cartilages (like an internal “breath rite” strip) to support the breathing. Although her external appearance has not changed drastically, this corrected the internal collapse of the nose and corrected her breathing difficulties. She stopped by to see us today for another unrelated problem and was kind enough to consent to us using her photos and story.