A challenging case of a 17 yo student with a severely deviated nose. An “extracorporeal septoplasty” was performed. This is done in a case where the deviation is so severe that is cannot be corrected properly without completely removing the septum, rebuilding it in the operating room and replacing it in the nose. He is shown before and again, just 6 weeks after his procedure. An open rhinoplasty approach was used with a small incision placed across the columnella. He is thrilled with the natural appearance of his nose after surgery and the improvement in his breathing.
Update: Our patient is now seen 2 ½ years after his surgery. His breathing and aesthetic correction remain excellent.
A woman in her late 40’s who is bothered by her nose being too “wide”. The trick here is to reduce the width of the nose and the tip, but not overly lower the dorsum of the nose, as is usual in a typical rhinoplasty. She is shown before and again, 22 months after an open rhinoplasty. After a small reduction in the nasal hump with a power burr, medial osteotomies were performed to narrow the nose as well as percutaneous lateral osteotomies. A non-destructive tip rhinoplasty was performed at the same time to correct the “boxiness” of the tip. We can expect the tip to continue to appear even more refined over the next year as swelling continues to diminish. She is already thrilled with the new appearance of her nose. It is narrower and proportional, and the minor dorsal hump is corrected but not overly lowered.
Update: Our pt is shown 4 years after her rhinoplasty and chin implant.
A 17 year old who is bothered by a dorsal “hump”. On exam he also has some deviation of the nose. He is shown before and again, 6 weeks after an open septorhinoplasty. Bilateral spreader grafts were placed to prevent an “inverted V” deformity which is more likely when lowering a large dorsal hump. A portion of the septum was used as a strut to support the tip, which is left just higher than the nasal dorsum to give a “tip break”. He is already pleased with the appearance of his nose. He will develop more refinement as swelling typically diminishes over the next 3 years.
A man in his mid 20’s who is bothered by a “ hump” on his nose as well as difficulty breathing. He also has a severe deviation of his nose and septum. He is shown before and again,
6 weeks after open rhinoplasty with septoplasty and spreader graft placement. His contour is quite good at 6 weeks, but he will continue to see a subtle improvement over the next 3 years as swelling continues to slowly resolve.
A professional in her mid 30’s who is bothered by a crooked nose, dorsal hump, difficulty breathing. On examination she was noted to have significant deviation of the septum as well as vestibular stenosis. Vestibular stenosis is the collapse of the nose when someone breathes in that takes place at the “nasal valve” area and is often temporarily improved with “Breath rite” strips. She was also noted on exam to have a “weak chin”. The chin falls behind an imaginary line that touches the upper and lower lips. She is shown before and again,4 months after an open rhinoplasty with correction of the vestibular stenosis by placing “spreader grafts”, a match stick shaped piece of the septal cartilage. She also had a medium chin implant placed. She is thrilled with her early improvement, and no longer has obstruction of her breathing. Her husband notes that she no longer snores at night. The nasal tip will continue to gain refinement over the next 2 1/2 years. The slight pinkness of her nose is a sunburn from the weekend.
Our patient is now shown 16 months after surgery. The nose appears even more refined as the swelling in the nasal tip diminishes. We can typically expect the nose to improve for the first 3 years after surgery. She is thrilled with the natural appearance of her surgery. Friends and relatives know that she looks better but are not sure why. We have moved her closer to the aesthetic ideal, and people can tell that she looks better, but assume that she has gotten a new hair style.
A young woman in her mid to late teens who was troubled by a small dorsal hump and a drooping nasal tip. She is shown before and again, 6 months after an open rhinoplasty. The nasal tip will continue to gain in definition and refinement over the next 2 1/2 years as the typical swelling after surgery continues to diminish. She is already thrilled with the improvement of her nose after surgery, and notes that her breathing is improved as well. Her case is a challenge because of the weakness of the tissues around the tip. A “columnellar strut” fashioned from septal cartilage as well as special suturing of the tip allowed us to improve the projection and give her a slight “tip break” with the tip sitting higher than the dorsum after surgery.
She is seen again 17 months after surgery. The nose typically continues to improve in appearance for 3 years after a rhinoplasty, as swelling in the tip slowly goes away. Although her nose looked good shortly after her surgery, we can see continued “refinement’ in the appearance of her nose as the structure created at the time of surgery is slowly revealed.
A woman in her mid 40’s who is troubled by her nose “drooping” and a dorsal hump. She also has difficulty breathing, and needs to wear Breath Rite strips to breath better. Her exam showsthat she does have collapse at her internal nasal valve, “vestibular stenosis” She is shown before and again, 9 months after open septorhinoplasty with non destructive tip rhinoplasty andbilateral spreader graft placement. There is typically still some swelling in the nasal tip that will continue to improve for 3 years after surgery. She is thrilled with her new nose, andis able to breath in normally through her nose without obstruction, and with our needing to wear an external support.
A young man in his late teens who has had a broken nose in the past. He was troubled by the nose being crooked, as well as by the dorsal hump. He wanted to have a natural appearance after surgery and be able to breath better. In addition to a severe deviation of his septum, he had internal collapse of the “internal nasal valve” when he inspired. This is also know as “vestibular collapse” and is the obstruction that is often made better with “Breathe Rite” strips. He is shown before and again, 6 months after a septorhinoplasty with an external approach/ incision across the columnella and a non-destructive tip rhinoplasty. In addition to straightening the nose and septum, “spreader grafts” were placed. This is a match stick sized piece of the septal cartilage that is placed just below the upper edge of the septum and prevents collapse in this area when he breathes in. He is thrilled with the appearance of his nose 6 months after surgery, and can breath without nasal obstruction. The nasal tip area will typically continue to improve in appearance and definition for about 3 years after surgery.
A woman in her early 40’s who was troubled by a bulbous tip and a minor hump. She felt she had “a bulb on the end” of her nose. She also had some internal nasal valve collapse, the type that is improved with “Breath rite” strips. She is shown before and again, 2 years after an open rhinoplasty combined with spreader graft placement to correct the valve collapse. She is thrilled with the improved shape of her nose, and is able to breath more easily as well. An open rhinoplasty was performed through an incision across her columnella.
A woman in her mid 30’s who was bothered by a “hump” and a tip which “drooped”. Her early photos are shown 6 weeks after an open rhinoplasty. Although she already has an excellent result, we can expect that the tip will continue to improve in appearance over the next 3 years as subtle swelling present after surgery continues to resolve.
Our patient is now seen at 3 months after surgery. Her breathing obstruction is now corrected as the swelling has diminished. The nasal shape achieved at surgery is better seen as swelling continues to diminish.