This gentleman had multiple rhinoplasties before. He has a Gore-Tex implant on the dorsum, pinched and upturned tip, narrow middle vault, and nasal obstruction. Surgery included replacing Gore-Tex with rib cartilage, septum and middle vault reconstruction, tip lengthening with new septal extension grafts, and medial and lateral reinforcement with cartilages. After surgery, his nose looks normal and he can breath much better. I used special technique called "grated cartilage paste" on the tip area. Grated rib cartilage was made as paste using patient's own blood and used as tip onlay graft. This gives volume not only on the tip but also on the lateral margins of the tip, which makes a more natural tip apprearance.
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.
Comments
Post a Comment