Description

22 year old female presents 6 months s/p septorhinoplasty with cartilage grafting. She is happy with her aesthetic result.  A septoplasty was performed to harvest cartilage. An open rhinoplasty allowed for exposure. Hump takedown was performed with a 15 blade scalpel. Bilateral spreader grafts were placed between the upper lateral cartilages and septum. This with the upper lateral cartilages were resecured to the septum with multiple 5-0 prolene and 4-0 PDS mattress sutures. The nasal bone and midvault cartilage were further contoured with the piezo saw. The domes of the lower lateral cartilages were divided. We then moved to tip refinements. Cephalic trims of the lower lateral cartilages were done leaving 8 mm lateral crural struts. Dome spanning sutures were placed to create tip defining points. Lateral alar control suture was then placed to approximate and secure the domes. Lateral alar flaring suture was placed to flatten the lateral crura. The medial crura were dissected from the vestibular skin. A tongue-in-groove stitch was placed to set back the medial crura on the caudal septum. A medial crural fixation stitch was placed to bring the medial crura together.