"This female patient seeking consultation for revision rhinoplasty presented with a number of aesthetic concerns that included: As seen on frontal projection: crookedness of the nose to the right starting at the rhinion and including the middle vault with tip asymmetry, bifidity of the tip with pinching, middle vault collapse with an inverted-v deformity, as seen on lateral projection: a low dorsum and an inferiorly-displaced radix, alar retraction, evidence of an absent or concave lateral crus, and an under-rotated tip, and on base view: asymmetry of the nostrils with evidence of external nasal valve collapse. In addition, the patient had functional concerns secondary to a septal deviation and internal and external nasal valve collapse. Correction was accomplished via an open approach utilizing trancolumellar, marginal and intercartilaginous incisions. Surgical maneuvers included: septoplasty with elevation of bilateral lining flaps, placement of extended spreader grafts, dorsal augmentation and placement of a radix graft using septal cartilage, medial osteotomies, interdomal and intradomal sutures, placement of bilateral alar batten grafts and alar contour grafts, placement of bilateral composite cartilage grafts to improve alar retraction, placement of a columellar strut, shield-like tip graft and a crushed onlay tip graft. Grafting material was harvested from the auricles bilaterally. The caudal surface of the medial crura were reduced and plumper grafts were placed to augment the maxilla. From: Fedok FG: Surgery of the Nasal Tip. In: Rusko J, Sataloff R, Sclafani A (eds.): Sataloff’s Comprehensive Textbook of Otolaryngology, Japypee Brothers Medical Publishers, Philadelphia, 2016. "
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By Dr. Fedok, a well-respected and widely published double board-certified plastic surgeon whose before and after gallery, RealSelf and Google Reviews reflect his trusted expertise.
