Case #3985

Description:

This lovely patient is 1 year out from a very challenging tertiary rhinoplasty.

Despite two prior rhinoplasties performed elsewhere, she still experienced nasal obstruction and disliked how far out her nasal tip projected.

Her prior surgeon had accidentally perforated her nasal skin during her 2nd surgery, resulting in two pitted scars along her dorsum. About a week after the same surgery, she noticed her nasal tip deviated to the right.

During surgery, her nasal cartilages were noted to be severely weakened, presumably from prior over-resection. She had tip bossae where the tip cartilages formed knuckle-like protuberances. Her septum remained S-shaped, crooked anteriorly, and was cracked about halfway on the bridge, which may have explained why her nose became deviated only 1 week after her last surgery.

To reconstruct her nose, we utilized rib cartilage to create 8 different grafts. We deprojected her nasal tip using a dome truncation technique, a deprojection maneuver reserved for those with poorly deformed tip cartilages. Because of her thin skin, we laid a sheet of acellular dermal graft to soften her nasal contours. Despite adding multiple grafts, we improved her breathing and deprojected her nose to make it smaller simultaneously.

She is 1 year out from surgery and will continue to improve over time. She is also 1 month out from CO2 laser resurfacing of the pitted scars on her nasal bridge.

We are grateful that she has given us permission to share her photographs.