Description

Operation:

Revision Joseph Rhinoplasty, Revision Septoplasty, Turbinate outfracture, Costal Cartilage Graft. Left SEG, Left Spreader, Bilateral Lateral Crural Strut Grafts, Left Batten graft, Crushed Cartilage Supratip Graft, Right alar rim graft.

Indications:

29 year old female presents today in consultation for aesthetic and functional nasal concerns. She is bothered by asymmetric nostril shape and a left lateral sidewall depression.

Description of Procedure:

Pre-operative diagnosis:
Aesthetic nasal concerns

Post-operative diagnosis:
Aesthetic nasal concerns

Procedure:

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. A SMAS flap was dissected out separately. 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 previously performed leaving 8mm wide lower lateral cartilages. A septal extension graft and left spreader graft were previously placed. Bilateral lateral crural strut grafts were 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. A crushed cartilage graft was placed and secured with 5-0 chromic to the supratip break in order to soften the slope. A batten graft was placed on the left over the midvault. A right alar rim graft was placed.