Patient Photos

Tertiary Revision Rhinoplasty Using Rib Cartilage Before and After Photos To Correct Over-Shortened Nose and Saddlenose Deformity

This Bellingham revision rhinoplasty patient consulted with Thomas Lamperti, MD after suffering prior nasal fractures and then undergoing three prior rhinoplasty surgeries to try to return the patient's nose to its original shape. Unfortunately, despite these prior surgeries she was left with an over-rotated and over-projected tip along with a saddlenose deformity as evidenced by a depressed supratip area. The patient was also interested in narrowing the overall width of her nasal bones in addition to improving the overall asymmetry her nose still had. Since the patient had already had septoplasty surgery in which any available cartilage was removed during her prior surgeries Dr. Lamperti used rib cartilage to rebuild the patient's nose. She opted to use tissue bank rib cartilage rather than her own. Using an open rhinoplasty approach the patient's tip cartiages were mobilized and counter-rotated into a more natural position. An extended spreader graft was carved and used as a supporting strut to keep the tip in its new position. Additionally, the patient's tip was deprojected. This maneuver was assisted by the fact that Dr. Lamperti performed a medial crural overlap as the medial crura were too long to allow for proper tip projection otherwise. Osteotomies were done to narrow and refine the patient's bridge width. To correct the patient's saddlenose an onlay cartilage graft was placed in the supratip area to soften the depression in this area. To support the patient's external nasal valves bilateral alar batten grafts were placed. In the 4 month after photos you can see how the patient has a much more natural and pleasing tip position. Her profile line is also much smoother with a les aggressive supratip break. The patient's asymmetry is also improved as evidenced on base view and the position of the columella. Importantly, the patient also notes improved nasal airflow and congestion and she reports that her nose now looks like her original one again.