Preservation Rhinoplasty Case 21296 - Dr. Jose Barrera: San Antonio Facial Plastic Surgeon & ENT

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Gender: Female

Description

21 year-old female presenting today in consultation regarding aesthetic nasal concerns. Patient desires dorsal hump reduction, tip refinement and a straightened more symmetric nasal pyramid . She shares that she is a basketball player and has sustained multiple minor sports injuries to the nose over her life. She denies prior nasal surgery. She denies issues with nasal breathing. Dr. Barrera performed a Primary cosmetic preservation septorhinoplasty with septal cartilage grafting (left SEG). A modified through and through dorsal cartilage z plasty incision was performed along with an osteotomy through the perpendicular plate of the ethmoid bone to allow for let down of the dorsal hump. At this point, the nasal dorsum was fully let down. A 5-0 prolene was placed around the excised septal cartilage segment to hold the let down dorsal hump in position. An inferior oblique incision is then carried caudally through to the anterior septal angle to level of cartilaginous dorsum.

Inferior septal cartilage was harvested in one piece with care taken to maintain greater than 1.5 cm L strut. The anterior left upper lateral cartilage was released from the septum. Cephalic trims were performed leaving 8mm wide lower lateral cartilages and releasing the scroll. A septal extension graft was fashioned from the harvested septal cartilage and secured to the maxillary crest and left side of the native septum with 4-0 PDS and 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. The skin was elevated off the medial crura. A tongue-and-groove procedure was performed and the medial crura were sutured to the caudal septum with 5-0 prolene. Medial crural fixation sutures were placed to secure the medial crura together and narrow the columella. The patient is shown 6 months post-op.

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