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This 30 year old Suffolk woman came to discuss secondary (or revision) rhinoplasty.  She had cosmetic rhinoplasty at age 16 and since then was unhappy with her profile.  She had some difficulty breathing on the left which became much more severe after a child head butted her on her nose two years previously.  With much discussion and digital imaging, our plans were to dramatically improve the shape of her nose making it look more natural as well as improving her breathing.  Upon examining the inside of her nose, I found a severe septal deformity and her tip had become displaced and fallen as a result of her previous surgery.  Scarring from her previous surgery had distorted the nostril rims as well.  My goal was to give her as ideal shape as possible while dealing with an additional complexity of extremely thin skin.  We discussed the possibility of needing rib cartilage, but we were able to perform the rhinoplasty with her own septal cartilage and ear cartilage.  To improve upon breathing and make her nose more straight, her septum was repositioned including the lowest part near her upper lip.  However, this maneuver only addressed part of the breathing problem, as her sidewall had collapsed as well.  Her own cartilages were too weak and collapsed to hold her breathing passage open and so grafting would be necessary to strengthen and reposition them.  Her tip was very weak and another graft was necessary to hold her tip in position.  From her previous surgery, her left nasal bone was pushed inward creating more crookedness and affecting her breathing as well.  I was able to push her left nasal bone back out and hold it into position with several grafts.  Now almost seven months following her surgery, she is extremely happy with the natural appearance of her nose and her improved breathing.  At the time of her surgery she had fat grafting to the hollows along her lower eyelids, to the inside of her cheeks and in front of the jowl areas.  She also had fat grafting to fill out the temples. 

Surgeon: Dr. Thomas Hubbard

Case Number: 546

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