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This patient is 36 years old and was bothered by the crookedness of her nose and the tip dropping down when she smiled.  She had a rhinoplasty in her native England at age 19 but several years later fell from a horse resulting in more crookedness and also some difficulty breathing on both sides.  Along with the considerable crookedness, I noticed that her tip was low for the relative height of her bridge and also looking from the side, the angle between her nose and upper lip was too sharp. This could be due to her previous surgery, trauma, or both.  I had a very detailed consultation with the patient and we developed a long list of issues to address with her rhinoplasty.  The goal was to make her nose as straight as possible while creating a nice feminine shape and also improving her breathing at the same time. I have written extensively and presented nationally and internationally on subtle tip repositioning that would be required with this patient.  There are now advanced surgical techniques that can predictably reposition the tip.
During surgery, I found her septum was extremely crooked and traditional methods of straightening her septum would leave her with a residual breathing problem and crookedness.  Therefore, much of her septum was removed, dissected and reconstructed by using the straightest pieces available.  With this reconstruction, I was able to make her septum not only more straight but with improvement of the tip position and also the relationship between the nose and the upper lip.  The recovery for this type of combined reconstructive and cosmetic procedure is actually no longer than most rhinoplasties.  The patient is thrilled with her straighter and more natural looking nose and the tip position, both with and without a smile.  The bumps and irregularities from previous surgery and trauma were taken care of and her breathing greatly improved. 

Surgeon: Dr. Thomas Hubbard
Patient Age: 36

Case Number: 109

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