Rhinoplasty Before & After Case 197

This 17 year old woman from the Flower Mound region of Texas disliked her profile appearance due to a hump on her nose. She was bothered by mouth breathing and noticed some difficulty breathing thru the left side of her nose. During my examination, the external findings of the dorsal hump with deviation to the right and a broad tip were readily apparent, but I was very impressed with her internal exam. She had a very significant high deviation of the septum to the left--it was such a sharp deviation that it gave the appearance of a septal cleft or perforation when viewed from the right.

We agreed that an open septorhinoplasty was the appropriate operation to address both her cosmetic concerns and functional issues. The surgery was uneventful but quite interesting. I started with a component dorsal hump reduction and caudal septum resection. I then proceeded with the septoplasty, where I found that the deviation was created by marked body overgrowth of the vomer. A healthy L strut was left after harvesting donor cartilage, and then I resected the excess vomer that had been creating the internal nasal obstruction. I then proceeded with the cosmetic component of the surgery. A right sided low-to-low infracture was performed to address bony deviation, and then bilateral spreader grafts were placed to maintain her dorsal lines and prevent airflow problems. A columellar strut was placed for tip support, cephalic trims were performed to decrease tip volume, and finally sutures were used to define the nasal tip. 

Her recovery was uneventful and she now loves her nose. At 3 weeks after surgery, she even said that she sometimes “forgets” that she just had surgery and does not notice any breathing difficulties. Photos still show a significant amount of swelling, but the desired profile changes are evident.