Description

Operation: Primary Preservation Rhinoplasty, Septoplasty, Nasal Valve Repair, Turbinate Reduction, Costal Cartilage Graft, Left SEG

Indications: 26 year-old female presenting today in consultation regarding aesthetic nasal concerns. Patient desires dorsal hump reduction, increased tip rotation for a ptotic nasal tip, tip refinement, straightened nasal pyramid .

Description of Procedure:

Pre-operative diagnosis:
Aesthetic nasal concerns

Post-operative diagnosis:
Aesthetic nasal concerns

Procedure:
Preservation open septorhinoplasty with costal cartilage grafting

The patient was brought to the OR and identified by name and date of birth. IV anesthesia was administered and an LMA was placed. The nose and septum were infiltrated with 1% lidocaine with 1:100,000 epinephrine. The patient was prepped and draped in the standard sterile fashion.

An inverted V columellar incision and marginal incisions were marked out and incised. The soft tissue envelope was lifted off the cartilage and bony framework. The periosteum over the nasal bones was incised and elevated. Functional septorhinoplasty was performed and dictated separately.

The nasal bones were then contoured with the piezo to improve symmetry and narrow the upper vault. Cephalic trims were performed leaving 8mm wide lower lateral cartilages. A septal extension graft and left spreader graft were previously placed. 5-0 prolene dome spanning, lateral crural tensioning, and alar flaring sutures were placed to create new domes and increase rotation, securing the lower lateral cartilages to the septal extension graft. A transdomal 5-0 prolene was placed to secure the domes just above 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.