Description

Operation: Primary Joseph Rhinoplasty, Septoplasty, Turbinate Reduction, Nasal Valve Repair, Costal Cartilage Grafting, Left SEG, Right ANSA banner graft

Indications: 40 year-old female presenting today in consultation regarding aesthetic nasal concerns. Patient desires reduced nasal base, tip refinement, narrowed nasal dorsum . Patient also endorses bilateral nasal obstruction (L>R).

Description of 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. Costal Cartilage was prepared and carved into our SEG. 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 .