Correction of a Deviated Nose After Septal Extension Grafting #DeviatedNose #Rhinoplasty #RevisionRhinoplasty

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My dorsum and tip became crooked after rhinoplasty!

What should I do?

When a septal extension graft is used to increase the height and length of the tip, 

the skin of the tip pushes back against the extension graft at the tip, and 

we often see the septum connected to it become deviated as well.

What kind of surgery is needed in such a case?

PH

4 years ago, the patient had augmentation rhinoplasty with silicone, a septal extension graft with septal cartilage & a cap graft with ear cartilage,

and alar reduction (lateral incision).

P/E

The silicone was displaced to the left, the septum deviated to the left / and the tip was also displaced to the left.

The tip was fixed and hard / the nose was long and the tip drooped.

OP

* Silicone, capsule, 2 layers of septal extension graft fixed on both sides, ear cartilage onlay (cap graft)

    & derotation graft: removed 

* The septum, displaced to the left, was straightened with a swing-door technique  

    the end of the septum was reinforced (batten type) with cartilage from the removed septal extension graft, and 

    a septal spreader graft was placed

* The columellar strut that had been set up with ear cartilage was left in place

    the tip onlay graft was crushed and used to fill the supratip and the depressed part of the dorsum

A: The columella leaned to the patient's left, and the tip cartilages were buckled.

B: After the silicone was removed.

C: The septal extension graft being removed.

A: After the silicone and septal extension graft were removed, the septum is shown to be deviated.

B: The septum was moved to the midline with a swing-door operation,

and the end of the septum was reinforced with the removed extension graft.

C: After the columellar strut (ear cartilage) and spreader graft were placed.

A: The removed silicone, capsule, septal cartilage pieces, and ear cartilage.

B: The columella and tip cartilages now stand straight.

The dorsum and tip, which leaned before surgery, are now straight.

The bridge, long and unnatural because of the silicone implant, now looks natural. 

The tip, which leaned slightly to the left before surgery, now stands straight.

The long, unnatural bridge and tip shape now look natural.

After removal, the tip looks more defined.