Nasal obstruction developing after rhinoplasty is increasing. Diverse etiologies are involved and evaluation is not always straightforward. Analyzing the anatomic etiology needs thorough physical examination, radiologic evaluation, and functional tests. There are a lot of armamenterium to improve the nasal airway, but a wise choice of these techniques is very important. In addition to the improvement of the airway, patient also requests aesthetic improvement. Achieving these two goals is often tricky and requires experience and skill.
This lady in below photos had nasal deviation, hump nose, and tip ptosis with breathing difficulty. Septum was corrected first, and this made the lower 2/3 of the nose straight. Hump was not resected but rasped with Piezotome and this did not breach the keystone area, which made spreader grafts unnecessary.Bilateral osteotomies with Piezotome made her bone straight. Together with septum correction and effective osteotomies, her nose became straight from the frontal view. Tip was modified with sutures and onlay graft only. No strut or septal extension graft was used and this made the tip soft even after considerable amount of rotation and projection increase. Radix was augmented with bruised cartilage. Overall, she could breath much better after surgery and her nose became more harmonious and feminine.
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