Preoperative Diagnosis: nasal obstruction, turbinate hypertrophy, deviated septum, small dorsal hump, narrow middle vault, hanging columella
Procedure: primary open rhinoplasty, septoplasty, turbinate reduction. Osteotomies were performed. Spreader grafts were placed.
Findings: septum dislocated to right with posterior bony spur to left, bilateral turbinate hypertrophy, significant bony/cartilaginous dorsal hump deformity, tip ptosis secondary to weak tip support, excess columellar show, bilateral narrow middle vault and internal nasal valve collapse, bilateral retracted ala .
Comments: Postoperatively, the patient has a relatively subtle but meaningful change. The profile is straighter, stronger and the tip is at a more appropriate height. On frontal view, the middle third of the nose has been slightly widened to improve breathing, which also makes the tip appear less wide.