Rhinoplasty Before & After Case 1
A septorhinoplasty and revision of her pharyngeal flap improved her breathing and refined her nasal tip, with no negative effects on her speech.
There’s nothing like being able to get a good night’s sleep!
Rhinoplasty Before & After Case 2
She is seen here early in her recovery, and can already breathe much more easily.
She also said we “gave her back her smile!” after revising the notch in her cleft lip.
Rhinoplasty Before & After Case 3
I performed a rhinoplasty to straighten a deviated septum, and used the removed cartilage from the septum to make grafts that helped to straighten and support the nasal passages.
We also chose to perform a genioplasty, moving the chin forward to balance his facial features.
Rhinoplasty Before & After Case 4
I performed an open rhinoplasty, with straightening of his septum and use of the septal cartilage along with ear cartilage to straighten and support his nose.
His breathing and symmetry is already much improved at 1 week after removal of his splints.
We also repaired a small notch in his lip, and performed fat grafting to his upper lip and a bone graft to his cheeks to improve his facial harmony and balance.
Rhinoplasty Before & After Case 5
The septum (or wall between the two nostrils) is deviated away from the cleft, and the cartilage on the cleft side is usually smaller and weaker.
Correction of the deviated septum, and use of the cartilage for grafts to buttress the airway, helped to improve his nasal symmetry and ease of breathing.
Rhinoplasty Before & After Case 6
I performed an open rhinoplasty to straighten her nose, including nasal osteotomies, dorsal hump reduction, and refinement of her nasal tip.
She returned at one week with a huge smile and amazement at how much better she can breathe! She is also pleased with a refined nasal contour that still harmonizes with her face.
Rhinoplasty Before & After Case 7
She came to us with difficulty breathing and severe deviation of her dorsum.
Bruising and swelling is expected early on, especially if the nasal bones need to be repositioned as was done here.
Her septum was straightened and reinforced with cartilage grafts that helped support her internal nasal valve.
I also filled in a small notch in her right alar rim with cartilage where the rim had been pulled up years ago from a skin cancer reconstruction.
I love paying attention to these finishing details to make the results as great as I can!
Call our office today if you have a crooked nose we can help straighten, and let you breathe through it again!
Rhinoplasty Before & After Case 8
We performed an open rhinoplasty using spreader grafts and nasal bone reduction to smooth her contour and help her breathe better than ever!
Here she is seen at 2 weeks after splint removal. Swelling will continue to come down with taping and time. We can’t wait to see her final results!
Rhinoplasty Before & After Case 9
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 passages, and to fill in the deep depression at the left alar groove.
Removing the crooked septal cartilage also helped open up his nasal airway.
The lip was re-repaired, with removal of the irregular scar tissue and improved balance of the height and width of the skin, dry mucosa, and wet mucosa, along with the underlying muscle.
Each of these components must be addressed individually, as well as all together kept in balance.
His swelling will continue to improve for at least 9-12 months, though some patients report improvement even at 18-24 months. He is seen here at 4 months.
Rhinoplasty Before & After Case 10
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 a closed technique (incisions all inside the nostrils), to straighten the septum.
Cartilage grafts from the removed septum were then used to straighten and support her nose.
She is seen here 1 month after her surgery, breathing better than ever! Swelling gradually improves over the next 6-12 months.
Rhinoplasty Before & After Case 11
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 extended into his nasal passage, the deviation was more and more apparent, causing almost complete blockage of air movement on one side.
Correction of the deviated septum – and use of the septal cartilage grafts to the dorsum and cleft side of the ala – greatly improved his breathing.
He also has an improvement of his definition and symmetry, even at just 1 month after surgery with more improvement of his swelling still ahead of him.
Cleft Rhinoplasty Before & After Case 12
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 years as a child grows. The scar tissue also usually does not grow as well as the surrounding skin, so even slight over-lengthening can still leave that side shorter over time.
Here, a cleft rhinoplasty and revision of the lip scar opened up her breathing tremendously. Her symmetry of the tip and wings of the nose is improved, with some upward rotation and tip support added.
Her lip was also revised, with a strong focus on not just the skin, but rebalancing the muscle height and direction of the muscle fibers.
As always, the scars will fade and flatten with time and care. She is seen here at 3 weeks after surgery.
Cleft Rhinoplasty Before & After Case 13
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.
In the same setting, her fractured septum was straightened, and cartilage grafts including spreader grafts and columellar grafts helped to let her breathe through her nose!
Her dorsum is now more regular, and her tip more refined and rotated up.
These are some of my favorite surgeries, tailoring surgeries to each person’s individual goals and needs, all while making sure they’re breathing like never before!
Cleft Rhinoplasty Before & After Case 14
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 smile says it all! Nearly 100% of our cleft patients have difficulty breathing.”
Factors include the septum deviating away from the cleft towards the nostrils from the asymmetric pull of the orbicularis muscle and other soft tissue attachments seen with most repairs historically. Further back, the septum follows the bone deviating and collapsing towards the cleft.
Other considerations are weak and collapsed cartilage in the middle and lower thirds of the nose, and compensatory inferior turbinate hypertrophy.
Structural rhinoplasty was performed via an open approach, with spreader grafts, lower lateral cartilage repair (with reorientation of his previous surgical repair), and septal extension graft. Turbinate outfracture and ablation is used adjunctively based on palpation and exam after correcting the deviated septum.