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, she had an over-rotated and over-projected tip along with a saddlenose deformity as evidenced by the depressed supratip area. The patient also wanted to narrow the width of her nasal bones. The patient had already undergone septoplasty surgery in which all the available cartilage was removed during her prior surgeries so 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. As the tip was placed in its new position it was also 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. To narrow and refine the patient's bridge width medial and lateral osteotomies were also performed. 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 as well. 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 less aggressive supratip break and saddlenose. The patient's asymmetry is also improved as evidenced on base view and the position of the columella. Importantly, the patient notes improved nasal airflow and she also reports that her nose now looks like it originally did again.