Patient with previous rhinoplasty 20 years ago. Presents with both aesthetic and functional problems. Aesthetically she has very thin skin which has contracted over her cartilage showing irregularities. The tip is rotated up resulting in shortening. Nostrils are asymmetric and poorly supported. Tip is contracted causing under projection and emphasizing mild dorsal prominence. The middle nose is collapsed causing airway blockage. This is one of the most difficult challenges in rhinoplasty. Specifically the loss of structure, upward rotation of the nose with skin contraction and very thin skin which predisposes to severe shrinkage are challenging. A versatile and multi technique approach is needed. Patient is seen 9 months post op revision rhinoplasty. The tip has been derotated with septal extension grafting and has been stabilized to this structure. The middle vault supported with spreader grafts and the tip and nostrils rebuilt with ear cartilage grafts. Breathing has been restored and symmetry improved. The profile was matched to the new tip position (both in accordance with the patient's goals). The entire skin of the bridge, middle nose and tip was relined and supported with fascia to control skin shrinkage.
- Michael L. Schwartz, M.D.
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- United States, FL, West Palm Beach, 1515 North Flagler Drive, #920, 33401
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