PROCEDURE: Open rhinoplasty with placement of spreader grafts, lateral crural strut grafts, repositioning of lower lateral cartilages, placment of deep temporalis fascia, septoplasty and platelet gel application.

OTHER PROCEDURES: upper eyelid ptosis repair, lower eyelid fat repositioning.

FINDINGS: Malpositioned lower lateral cartilages with narrow middle vault.

COMMENTS: Improved appearance of nasal vault following reconstruction.

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