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When this 23-year-old woman was in fifth grade, she began to notice that her nose was becoming more and more crooked and she was having difficulty breathing.  At age 18 she underwent septorhinoplasty by a surgeon that did not realize the severity of her septal deformity and crookedness.  Therefore, his procedure gave her very little improvement in appearance or function. As we can see from her front photo before surgery, she still has very severe crookedness, mostly related to her septum. On the side view, one can see her tip is over projected.  During her first surgery, there was the best opportunity to replace the crooked parts of her septum with the straight pieces.  Unfortunately, this was not done at the time so when she came to discuss surgery with me, the straight part of her septum was no longer available.

I explained to her that with the severity of her crookedness and septal deformity it would be necessary to use rib graft for reconstruction, and that we would likely replace much of her crooked septum with rib cartilage.  Since her skin is extremely thin, we discussed using a thin sheet of temporalis fascia as padding.  She underwent septorhinoplasty with rib grafting.  During her procedure I found that her septum was so crooked and deformed that most of it had to be removed, and I completely reconstructed it with rib grafts.  The tip cartilages were also severely deformed, so grafting was necessary there as well. 

With severe crookedness, the surgeon will not know the exact septal problem until the time of surgery when it can be examined directly.  Sometimes more extensive surgery is necessary, and the surgeon must be prepared to use more advanced septal techniques when the situation arises. Decades of experience enables me to recognize those patients who will need these techniques and use them appropriately. Since her surgery, this patient’s breathing has dramatically improved on both sides, and her nose is much straighter. She will enjoy her natural-looking result, created using only her own tissues, for many years to come. 

Surgeon: Dr. Thomas Hubbard
Patient Age: 23

Case Number: 308

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