This patient had silicone implant on the dorsum and tip surgery with septal and conchal cartilage. As time passes, the tip and supratip area dropped and a step deformity of the dorsum developed. You can see the short silicone implant on the dorsum from the X-ray and the subsequent step deformity on the preoperative lateral view in the middle. Silicone was replaced with autologous cartilage and tip ptosis was corrected with cartilage support. It is sometimes difficult to expect how much the tip projection will decrease as time passes, but with proper technique using autologous tissue, the margin of error should be within 10%.
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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