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Goals
This patient in her 40s came to me for revision rhinoplasty after a previous surgery. She was concerned about a deviated nose and septum and an overall appearance that looked somewhat “done.” Her goal was a straighter, softer, more balanced nose that looked natural on her face.
Procedure
I performed an open revision rhinoplasty with correction of the deviated septum. Spreader grafts were used to straighten and support the middle vault. A septal extension graft allowed me to derotate and reposition the tip, while alar rim grafts provided additional support and refinement. Careful use of the remaining septal cartilage allowed us to achieve the necessary reconstruction without a rib graft.
Outcome
Her nose is straighter and better supported, with improved tip position and a softer, more natural appearance. She went from a nose that looked operated to one that is balanced with her facial features. She was very happy with her final result.
Key Principle
Revision rhinoplasty does not automatically mean a rib graft is necessary. This patient had seen several surgeons and had been told she would need rib cartilage. In the right patient, careful evaluation, preservation of existing structures, and meticulous use of the remaining nasal cartilage can provide the support needed while avoiding a rib graft. The goal is not to use more grafting, it is to use exactly what is necessary to create a stable, functional, and natural-looking nose.
