Secondary nasal reconstruction after old trauma or rhinoplasty surgery falls into that overlap of 1) what I enjoy doing, and 2) where we get consistently satisfying results. This patient had a previous trauma with reduction of the fractures done appropriately after her injury. Unfortunately, over time the deviation and airway collapse continually worsened. Open approach, structural rhinoplasty was required to … Read More

Septorhinoplasty is usually the final surgery for a patient born with a cleft lip. A few things combine to create common complaints: 1) Inherently different/less growth potential 2) Asymmetric and/or abnormal attachments of muscles and ligaments 3) Bony asymmetries 4) Scar tissue 5) Abnormal blood and lymphatic flow These inevitably lead to problems breathing, and often thick and scarred nasal … Read More

This man is breathing well at 7 weeks after his cleft rhinoplasty and fat grafting to his upper lip. Septoplasty and spreader grafts, with tensioning of the upper lateral cartilages over the grafts, helped his breathing. This is like having an internal Breathe Right strip people use for snoring and nasal collapse. His contour and projection match his face well, … Read More

This young man is breathing well and confident 1 month after his cleft rhinoplasty and fat graft to his upper lip. Not every patient requires a rib graft, or total deconstruction and reconstruction of the nose. Here, we used a spreader graft on just the left side of the nose, columellar strut graft, and suture techniques to unite, reorient, and … Read More

Usually we wait until after skeletal maturity and jaw surgery before offering a cleft rhinoplasty. However, if nasal obstruction and symptoms are severe, nasal reconstruction before jaw surgery is sometimes done, knowing that a second surgery may be needed after the maxilla is moved forward. Here, septal deviation and airway collapse led to nasal obstruction, sleep apnea, and difficulty with … Read More

This man came to us with severe facial asymmetry even after over 10 surgeries elsewhere for Parry Romberg Syndrome. Those surgeries included 2 free flap surgeries, but he still had a fair amount of asymmetry and tightness of the upper cheeks and soft tissue on the entire left side of his face. He has since gone through two surgeries with … Read More

“I’m feeling better… 110% better. I thought I had sleep apnea. My wife tells me my snoring went away… I’m just sleeping a lot better. Now I feel more rested and just breathing a lot better. Slow process of trying to actually breathe correctly for the first time in my life, through my nose instead of through the mouth. The … Read More

This athlete couldn’t breathe, with a history of a fractured and deviated septum, and a pharyngeal flap previously used to help speech for her cleft palate. For patients with a history of a pharyngeal flap, these may actually be divided and revised after several years, usually with no change in speech and nasality, but with much improved breathing and speech. … Read More

This beautiful girl has a history of a cleft lip and palate. She had severe nasal obstruction as is nearly always seen with our cleft patients, with septal deviation. She also had some imbalance of her lip, with the height of the skin several millimeters shorter on the cleft side. This can be seen with very small imbalances magnified over … Read More

This young man has done very well with his history of cleft lip and palate surgeries throughout childhood, and he came to us for his cleft rhinoplasty. First and foremost, he had difficulty breathing because of a deviated septum. From the front you can see a slight deviation of the bridge of his nose extending to the tip. As it … Read More

This beautiful patient is thrilled after her cleft rhinoplasty! She had the normal development we see with most cleft lip patients. Her septum was pointing to the right — away from the cleft side — causing severe nasal obstruction. She also had slumping and weakness of the cartilage and skin on the same side as her cleft lip. We performed … Read More

This handsome man had severe nasal obstruction and nasal asymmetry, with collapse and less growth of the left side of his nose. He also had a notch of his upper lip with some irregular scar texture. Open rhinoplasty was performed, with release of the old scar tissue, and multiple cartilage grafts from his septum used to support his collapsed nasal … Read More