Description

37-year-old male who desired a more aesthetically pleasing nose, hump reduction and tip refinement. He underwent Primary cosmetic preservation septorhinoplasty with septal cartilage grafting (right SEG, right spreader graft). A releasing Z septal incision and vertically oblique bony septum osteotomy was made. The modified Z flap was fully let down and a  4-0 PDS was placed around the excised septal cartilage segment to hold the let down dorsal hump in position.

Cephalic trims were performed leaving 10mm wide lower lateral cartilages. A septal extension graft was fashioned from the harvested septal cartilage and secured to the right side of the native septum with 4-0 PDS and 5-0 prolene. A small spreader graft was fashioned from patient’s septal cartilage and secured between the right upper lateral cartilage and septum with 5-0 prolene. 5-0 prolene dome spanning and lateral crural tensioning sutures were placed to create new domes and increase rotation, securing the lower lateral cartilages to the septal extension graft.