Over-rotated, Foreshortened Nose

This patient had a prior septorhinoplasty by another surgeon to treat a dorsal hump and under-rotated nose. The patient's bridge was over-resected and his nose over-rotated, however. Also, the lateral osteotomies were performed too high on the nasal sidewall leaving the patient with an incompletely narrowed nasal vault. Dr. Lamperti performed an open revision rhinoplasty using ear and septal cartilage to build up the upper portion of the patient's bridge to create a more natural profile line. Properly placed osteotomies produced a improved appearance on frontal view. Advanced grafting techniques were then used to de-rotate the patient's tip to produce a much less up-turned, natural appearing nose.

Twisted, pinched tip, pollybeak deformity and increased columellar show

This gentleman had a septo-rhinoplasty by another physician about 7 years prior to his initial consultation with Dr. Thomas Lamperti. He reported that his bridge was now straighter on profile but that he had difficulty breathing. Dr. Lamperti identified a persistently deviated nasal septum along with a twisted nasal tip and collapse of the left supra-alar region (the area just above the left nostril on frontal view). On profile view one can see that the patient also has rounding of his tip (also called a polly-beak deformity) and excessive columellar show and alar retraction. The patient is shown before and just 3 months after (with attendant swelling still evident) undergoing a revision septorhinoplasty. On frontal view one can see that the patient still has a significant amount of swelling to his tip. On base view a more symmetric tip is evident. The profile view shows the patient’s preoperative computer imaging in the middle pane and the 15 month result on the right. Already there is a more natural tip contour with a reduction in the amount of columellar show and alar retraction.

Severely pinched and overprojected tip, middle third collapse, excessive columellar show

Twisted nose requiring rib cartilage grafting

This patient had suffered multiple nasal fractures in the past and had undergone several corrective surgeries, including two septoplasties to make his septum straighter. Despite this the patient noted chronic bilateral nasal congestion and a very twisted appearance to his nose. On profile view, one can also note the patient’s poorly projected, droopy nasal tip and hump. In order to improve the patient’s nasal tip support and straighten his nose Dr. Thomas Lamperti used a rib cartilage graft (given the lack of residual septal cartilage to remove). This cartilage was then precisely carved and used to reconstruct the nose. On profile view, a natural, masculine bridge is evident along with a less droopy, better projecting tip. On frontal view one can see a straighter appearance to the nose with less tip pinching. The patient is shown 7 months after surgery so there is still significant tissue swelling evident, especially in the tip, that will continue to improve over the next couple years. The patient reports excellent breathing through both sides of his nose.

Rhinoplasty combined with chin implant

This patient had undergone 2 previous rhinoplasties before meeting with Dr. Lamperti. A revision septo-rhinoplasty was performed along with a chin implant placement. The patient’s dropping tip was improved along with her excessive columellar show. By increasing her tip projection Dr. Lamperti was actually able to improve the patient's tip definition. One can also see how the chin implant helps to balance the patient’s new tip projection. The after photos represent 8 month postoperative results.

Overprojected tip, middle third collapse and excessive columellar show

This woman came to Dr. Thomas Lamperti desiring improvement to her nose. She had undergone a rhinoplasty about 7 years previously. However, she was dissatisfied with her postoperative asymmetry and increased columellar show (one can see an excessive amount of the nostril on profile view). The patient was found to have an overprojected tip with a residual fullness to her bridge. She also had collapse of her left middle nasal vault. Dr. Lamperti performed a revision rhinoplasty using the patient’s septal cartilage. He was able to improve the tip projection, columellar show and middle third collapse while at the same time creating a more pleasing bridge line. While in the operating room Dr. Lamperti noted that after decreasing the patient’s tip projection, her nostrils became excessively flared. To treat this Dr. Lamperti also performed an alar base excision by removing a small piece of tissue from the floor of the nostrils. The patient is shown 3 months postoperatively and has expected residual tissue swelling, mainly of the nasal tip, that will continue to resolve over time.

Overprojected tip and pollybeak deformity after hump takedown

This woman came to Dr. Thomas Lamperti desiring improvement to the tip of her nose. She had undergone a septo-rhinoplasty about 4 years previously which improved the bony hump on bridge. However, she was dissatisfied with the residual fullness to the tip of her nose (best seen on profile view). During the preoperative assessment Dr. Lamperti also noted an asymmetric bulbosity to the patient’s left nasal tip and a slight deviation of the columella to the right. The tip was also overprojected and, given the patient’s height, over-rotated (too upturned). Dr. Lamperti performed a revision septo-rhinoplasty in which he encountered persistent septal cartilage and scar tissue causing the patient’s residual tip roundedness. Using cartilage harvested from the septum, he flattened the left tip to make it more symmetric with the right. He also rebalanced the patient’s tip projection and reduced the rotation slightly. On base view one can also see that the columella was made straighter. The patient is shown before and 3 years after her revision nasal surgery with Dr. Lamperti.

Revision rhinoplasty and ear cartilage grafting for severely pinched tip

This patient had a prior rhinoplasty procedure over twenty years ago. Over time the patient noted problems with chronic nasal obstruction. Preoperatively, the patient has significant tip pinching and marked asymmetry of her tip defining points. On base view, one can appreciate the patient’s columellar asymmetry and tip pinching. The patient is shown 1 year after undergoing a revision septorhinoplasty and right ear cartilage harvest where Dr. Thomas Lamperti straightened her deviated septum and then reconstructed the patient’s nose, recreating more natural and functional nasal contours. Even after one year there is some expected fullness of the patient’s nasal tip that will continue to improve.

Revision Rhinoplasty to Correct Nasal Tip Skin Cancer Pin-Cushion Scar and Under-Projected Tip With Polly Beak Deformity

This Seattle revision rhinoplasty patient sought out Dr. Lamperti nasal surgery expertise to help correct the deformity that resulted after having a skin cancer removed from her nasal tip by another surgeon a few years prior. A skin graft was used to repair the skin cancer defect but cartilage support was lost during the cancer resection. The patient presented to Dr. Lamperti with a severely blunted, under-projected tip with a pollybeak deformity. Using an open septo-rhinoplasty approach Dr. Lamperti rebuilt the patient's nasal tip, carefully elevating the patients skin off of her underlying tip cartilages. Her tip was placed in a more projected position and her bridge was also refined, creating a more elegant supratip break. During a planned second stage surgery several months later Dr. Lamperti excised the deep external nasal tip scar using an irregularizing pattern to further hide the pincushion deformity. After waiting about 3 months Dr. Lamperti then performed the last stage of reconstruction in which he performed scar dermabrasion to further smooth the nasal tip skin and scar. In the after photos which were taking several months after the scar dermabrasion you can see that the patient has a much improved tip projection and tip contour with a smoother bridge on profile views. The deep pincushion deformity is also improved which just residual, expected scar redness noted at this stage that would be expected to fade further with time.

Reverse Prior Rhinoplasty Related Pinched Tip and Narrow Nose Wtih Revision Rhinoplasty

This Vancouver, British Columbia rhinoplasty patient travelled from his home country of Portugal to have Dr. Lamperti help fix the aesthetic and functional problems he encountered following his prior rhinoplasties. The patient had undergone two prior closed rhinoplasties several years before but he was left unhappy with his overly narrowed, pinched tip along with the pinched middle third of his nose. He also had developed a tip bossa on his left dome region. Importantly, the patient also had chronic bilateral nasal blockage that failed to respond to chronic prescription allergy nose spray and antihistamine tablets. During his in office examination Dr. Lamperti also noted extensive scarring inside the patient's nostrils which had led to malpositioning of the patient's lower lateral crura. Dr. Lamperti also diagnosed a severely deviated nasal septum. The patient was really interested in recreating his prior nasal tip as much as possible. Dr. Lamperti performed an open revision rhinoplasty and septoplasty to correct the patient's issues. The upper nostril scar bands were divided which allow Dr. Lamperti to repair the vertically malpositioned lower lateral cartilages. This along with alar batten grafts improved the severe supra-alar pinching that the patient had developed. Spreader grafts were placed to correct the patient's inverted-v deformity. The patient's pinched tip was evidenced by his overly-narrowed tip defining points. Dr. Lamperti found that the nasal domes were only 5 millimeters apart. This is far too narrow for a male nose such as his. Dr. Lamperti therefore widened the tip using a spacer grafting technique in which a cartilage graft was placed between the nasal domes in order to place them 8 millimeters apart. In the approximately 10 month after photos you can see already how the patient has a much more natural appearing tip with corrected pinching and bossa.  You can also appreciate the wider nasal middle third. Importantly, the patient's breathing is markedly improved as well. It should be noted that the patient has some expected residual tip skin edema at this stage that should gradually improve further over the next several months.

Revision Septo-Rhinoplasty To Correct Hanging Columela and Alar Retraction

This Portland revision rhinoplasty patient came to Dr. Thomas Lamperti to find out what could be done to correct the problems she was having with her nose following two prior rhinoplasty procedures in Southern California several years prior. Her main concern was her drooping, hanging columella and excessive columellar show. Dr. Lamperti noticed that she also had alar retraction contributing to this excessive columellar show along with supra-alar pinching related to prior cartilage removal. The patient wasn't concerned with the tip pinching so Dr. Lamperti performed an open revision rhinoplasty which included a septoplasty to harvest septal cartilage. A tongue in groove setback was done to place the droopy columella further up toward the septum. Luckily, the patient's septum was long enough to just use the septum as the anchor point. To improve the alar retraction rim grafts were also carved and placed to bring the alar margins down somewhat. In the 7 month postoperative photos you can see how the patient's tip is now much more harmonious with a nicely reduced columellar show and the alar margins are much better positioned. Dr. Lamperti was also careful to maintain the patient's current, pleasing tip rotation.

Revision Bridge Augmentation Rhinoplasty To Replace Malpositioned Silicone Implant With Rib Cartilage

This Bellevue revision rhinoplasty patient suffered a severe nasal fracture many decades ago in which his bridge was crushed in a motor vehicle accident. The injury was repaired at the time using a silicone implant over the bridge to efface the depressed nasal bone injury. Unfortunately, the patient's silicone implant ended up becoming shifted out of place such that it was too far toward the left and down by the tip. This resulted in a obvious asymmetry and also an unnatural pollybeak type deformity as seen on profile view. Additionally, the patient had twisted tip cartilages and right alar rim retraction. Using an open revision rhinoplasty technique, Dr. Thomas Lamperti removed the patient's malpositioned silicone implant. Tissue bank rib cartilage was then carved to augment the dorsum and form a new properly sized dorsal implant graft in which the depressed nasal bridge was rebuilt creating a strong, straight profile line. The patient's crooked tip cartilages were straightened and supported using a caudal septal extension graft and a right rim graft was also placed to correct the patient's alar retraction. The patient's left supra-alar pinching was corrected using an alar batten graft. In the 4 month postoperative  photos you can see how the patient now has a much more natural, masculine, symmetric appearing nose. The patient's excess columellar show has been improved along with the alar retraction. Most notably, the patient's profile line is smooth and straight as it transitions from the upper bridge down toward the tip.

Tertiary Revision Rhinoplasty Using Rib Cartilage Before and After Photos To Correct Over-Shortened Nose and Saddlenose Deformity

This Bellingham revision rhinoplasty patient consulted with Thomas Lamperti, MD after suffering prior nasal fractures and then undergoing three prior rhinoplasty surgeries to try to return the patient's nose to its original shape. Unfortunately, despite these prior surgeries she was left with an over-rotated and over-projected tip along with a saddlenose deformity as evidenced by a depressed supratip area. The patient was also interested in narrowing the overall width of her nasal bones in addition to improving the overall asymmetry her nose still had. Since the patient had already had septoplasty surgery in which any available cartilage was removed during her prior surgeries Dr. Lamperti used rib cartilage to rebuild the patient's nose. She opted to use tissue bank rib cartilage rather than her own. Using an open rhinoplasty approach the patient's tip cartiages were mobilized and counter-rotated into a more natural position. An extended spreader graft was carved and used as a supporting strut to keep the tip in its new position. Additionally, the patient's tip was deprojected. This maneuver was assisted by the fact that Dr. Lamperti performed a medial crural overlap as the medial crura were too long to allow for proper tip projection otherwise. Osteotomies were done to narrow and refine the patient's bridge width. To correct the patient's saddlenose an onlay cartilage graft was placed in the supratip area to soften the depression in this area. To support the patient's external nasal valves bilateral alar batten grafts were placed. In the 4 month after photos you can see how the patient has a much more natural and pleasing tip position. Her profile line is also much smoother with a les aggressive supratip break. The patient's asymmetry is also improved as evidenced on base view and the position of the columella. Importantly, the patient also notes improved nasal airflow and congestion and she reports that her nose now looks like her original one again.

Revision Septorhinoplasty To Correct an Upturned Pointy Tip, Alar Retraction, Low Radix and Tip Pinching

This patient of Dr. Lamperti's travelled from Canada to have corrective revision rhinoplasty surgery following prior surgery that left him with an over-rotated, feminized nose with an overly-narrow, pinched tip. The patient wanted to restore a longer nose, like he had originally while also making his tip less over-done appearing. It was important to the patient for us to recreate an ethnically appropriate nose in addition to making it more masculine. Dr. Lamperti performed an open septorhinoplasty surgery to straighten the patient's septum. He then used the septal cartilage to place extended spreader grafts to correct the narrowing of the middle third of the patients nose and improve nasal airflow. These long spreader grafts also provided an internal support structure that allowed Dr. Lamperti to counter-rotate the patient's upturned tip. To create a more masculine bridge Dr. Lamperti placed a radix graft toward the top of the bridge to augment the area. Bilateral rim grafts were also placed to better support the patient's nostril margins and correct the collapse there. A spacer graft was placed between the patient's nasal domes to widen the inter-domal distance and make the tip less pointy. During this process plumping grafts were also placed to improve nasal symmetry as well. In the 26 month postoperative photos you can see how the patient now has a much more masculine tip position and stronger bridge and profile line. His tip is also more natural appearing with much improved pointiness and pinching. Importantly, the patient is very happy with his improved nasal appearance and breathing.

Closed Revision Rhinoplasty With Saddlenose Deformity Repair

This Seattle revision rhinoplasty patient had a prior closed rhinoplasty by another surgeon in the past. She had healed with a saddlenose deformity as evidenced by the excessively low depressed area in the supratip region as best seen on profile view. She was happy with the remainder of her nose so a closed revision septorhinoplasty was performed by Dr. Thomas Lamperti. He harvested cartilage from the patient's septum which he then carved into an onlay graft which he inserted inside the nose in the area of the supratip concavity. In the 8 month postoperative photos you can see how the patient now has a very smooth, natural appearing profile line with no more step off from her upper bridge to her lower bridge. On frontal view the onlay graft added more definition to the patient's bridge which was originally more washed out in appearance. The patient also had an upper eyelid blepharoplasty and revision subnasal lip lift.

Revision Rhinoplasty to Lengthen Upturned Tip,  Straigthen Crookedness And Reduce Hanging Columella

This Seattle revision rhinoplasty patient had a few prior rhinoplasty procedures out of state along with upper lip lift surgery. She was left with a deviated tip and a very upturned, shortened nose that she wished to make more harmonious and un-operated appearing. Thomas Lamperti, MD used an open rhinoplasty approach and tissue bank rib cartilage to address the patient's concerns. He custom carved a caudal septal extension graft from the rib cartilage which allowed him to counter-rotate the patient's tip downward so it was not angled so far upward. He also tucked in the columella so it was not so prominent. The tip rebuilding also allowed Dr. Lamperti to straighten the tip so it no longer tilted to the patient's right side. To address the patient's wide nostril floor Dr. Lamperti conservatively trimmed tissue from this area to further help with overall balance and symmetry. In the 11 month postoperative photos you can see how the patient's tip is now much more straight and her columella less prominent. Importantly, her tip has a more natural appearing downward angle as seen on the profile and frontal views especially. On the frontal view you can most appreciate how we are not looking as far up into her nostrils.