Patient Photos

Asian Revision Rhinolasty To Treat Upturned and Pinched Tip

This patient had undergone several prior rhinoplasty surgeries over the years including placement of a silicone bridge implant which had to be replaced due to an infection. Likely due to subsequent scar formation, the patient's tip had become quite upturned. The patient wanted to address this issue along with how pinched her tip appeared. An in person examiantion revealed significant external nasal valve collapse which was causing chronic nasal obstruction. Given that her bridge and implant were not causing any issues Thomas Lamperti, MD recommended an open revision rhinoplasty to address the patient's tip concerns, while leaving the implant in place. Due to the patient's age and lack of sufficient septal cartilage, cadaver rib cartilage was used for grafting rather than the patient's own rib cartilage. A caudal septal extension graft was carved from this costal cartilage. This allowed Dr. Lamperti to counter-rotate the nasal tip cartilage downward into a less upturned position. He also carved and placed bilateral alar batten grafts to address the external nasal valve collapse. The patient's tip definint points were measured intraoperatively using a caliper and found to be only 4 mm apart, which was the cause for the nasal tip pinching. Dr. Lamperti placed a cartilage spacer graft between the nasal domes to widen this distance to a more normal 7.5 mm. To create additional nasal tip de-rotation Dr. Lamperti also placed a shield graft. In the 1 year after photos you can see how the patient's upturned tip is nicely corrected with much less nostril show on frontal view. Additionally, her pointy tip looks more natural with a smoother transition from the tip defining points to the nostril (alar) margin.