Revision Rhinoplasty #22

Our beautiful 23 year old patient is seen one year following functional and cosmetic revision rhinoplasty surgery. Her first surgeon removed a dorsal hump, but he failed to correct her wide, over-projected, and droopy nasal tip appearance. Her breathing became worse after her first rhinoplasty. Her repair consisted of tip de-projection, rotation and narrowing for a less distracting nasal appearance. Her breathing was improved by placing spreader grafts since her internal nasal valves were narrowed. We also reduced her turbinates to further improve her airway.

An over-projected nasal tip is one that sticks out too far. In our experience over 22 years, we cannot overemphasize the importance of dividing the lower lateral nasal tip cartilages to have maximal control of tip configuration. We treat the nasal tip as a tripod. Two of the tripod’s limbs are the right and left lateral crural tip cartilages, and the third limb is the sutured medial crural complex, typically with a columellar shoring strut graft. Dividing the tip cartilages may allow the greatest flexibility for reconstructing a nasal tip appearance to be pleasing and unoperated in appearance.