Pinched tip with alar retraction

This man came to Dr. Thomas Lamperti regarding his chronic nasal obstruction. Besides having a deviated nose he also has a naturally pinched, narrow nasal tip. Dr. Lamperti reconstructed his tip and straightened his nose using an open rhinoplasty technique. Comparing the preoperative with the 1 year postoperative views one can note improved nostril retraction (best seen on profile view) and tip pinching lending the nose a more natural contour. The patient’s breathing is also much improved.

Twisted nose and drooping tip

This Seattle rhinoplasty patient was interested in improving his chronic nasal congestion and twisted external nose. Shown 6 months after surgery, one can see a striaghter allignment on frontal view. On profile view one can see how Dr. Lamperti raised the patient’s droopy tip slightly while maintaining a masculine appearance. Since the patient is quite tall, Dr. Lamperti did not want others to continually be looking up his nostrils.

Dorsal hump and overprojected, full tip combined with blepharoplasty

This Seattle rhinoplasty patient came to Dr. Thomas Lamperti concerned about the prominent bump on the bridge of her nose. She was also interested in improving the roundness of her nasal tip. The patient is shown 1 year after having an open septorhinoplasty and concurrent upper and lower lid blepharoplasty to address her eyelid fullness. Note the straighter dorsum along with the more refined, slightly rotated and deprojected nasal tip. On base view one can also see the tip narrowing that was achieved.

Wide, bulbous nasal tip with underprojected radix

This Seattle Hispanic rhinoplasty patient came to Dr. Lamperti desiring to reduce the width and fullness of her nasal tip. Using an open septorhinoplasty approach Dr. Lamperti was able to refine the patient’s bulbous nasal tip while at the same time conservatively reducing the width of her nostrils. Additionally, the patient profile was improved with slight tip deprojection and supratip refinement. The patient’s upper bridge was somewhat underdeveloped so Dr. Lamperti placed a radix graft (to the portion of the bridge between the eyes). Postoperatively, the patient has a more well-balance nose that better fits her facial proportions.

S-shaped nasal deviation, overprojected tip and sliding genioplasty

This Seattle rhinoplasty patient presented with a serpentine external nasal deviation along with a deviated septum. Additionally, her chin was underdeveloped. The patient underwent an open septorhinoplasty to straighten her nose and reconstruct her septum. Her nasal tip was deprojected slightly to better balance with the rest of her facial features. A sliding genioplasty was also performed to advance the patient’s chin bone forward. The middle panes on the frontal and profile views are the preoperative computer morphing results. As a result of the improvements to her airway the patient's snoring was also eliminated. The patient is shown 9 months after surgery.

Overprojected, under-rotated nasal tip and excessive columellar show

This Seattle rhinoplasty patient was concerned about how far her nose came out from her face (tip projection) and was interested in a more feminine appearance to her nose. During the preoperative examination note was made of the patient’s underrotated, overprojected tip and the slight excess columellar show (on profile one can see a little bit too much of her nostril). An open rhinoplasty approach was used to address these concerns. On the 20 month postoperative photos one can see that the tip has been deprojected and slightly rotated. The bridge has been made less strong and better fits this new tip position, leading to a gentle supratip break (the slight depression just above the nasal tip seen on profile view). The columellar show has also been improved.

Wide nasal bones combined with upper eyelid blepharoplasty

This Seattle rhinoplasty patient had concerns regarding the width of her bridge. During her initial consultation, Dr. Thomas Lamperti noted that the upper third of the patient’s nose was wide, but her nasal tip was well proportioned with the rest of her face. The patient underwent surgery using a closed technique, using only hidden, internal incisions that allowed Dr. Lamperti to narrow the patient’s nasal bones. Shown six weeks after surgery, one can note a narrower bony nasal vault which gives better shadowing and definition to her face.

Under-projected tip and dorsal hump after nasal fracture

This Seattle rhinoplasty patient suffered a nasal fracture about 8 months prior to his consultation with Dr. Thomas Lamperti. He noted that after his injury he developed a flattened, under-projected nasal tip and a bump on his nasal bridge. The patient was found to have a fractured septum which resulted in poor nasal tip support. During the patient’s surgery Dr. Lamperti reconstructed and straightened the patient’s septum. He also rebalanced the patient’s profile, taking down the dorsal hump. On base view one can see that by increasing the tip projection the patient’s nostrils change from a horizontal orientation to a more natural oblique orientation. The photos represent preoperative and 6 month postoperative results.

Overprojected tip and dorsal fullness

This Bellevue rhinoplasty patient was interested in improving her nasal breathing and making her nose smaller. Before surgery she had a very overprojected tip and excess bridge fullness. Using an open septorhinoplasty approach, Dr. Lamperti reduced the projection of the tip and set a new bridge line as best seen on the profile views. The patient’s tip was slightly narrowed and her septum straightened. The postoperative photos were taken 9 months after surgery.

Severely deviated nose with overprojection and dorsal hump combined with chin implant

This Seattle rhinoplasty patient had concerns regarding chronic nasal congestion and the size of his severely deviated nose. Dr. Thomas Lamperti’s preoperative assessment revealed a weak chin which exacerbated the perceived size of the patient’s nose. While undergoing a septorhinoplasty to correct his nose, the patient also had a chin implant placed via a small incision (in the area of a pre-existing scar) under his chin. One year postoperatively, the patient has a much improved overall balance to his face. Though his nose was made smaller, by improving the chin projection Dr. Lamperti was able to maintain a strong, masculine profile for the patient.

Pinched tip with bossa and dorsal hump

This male Seattle rhinoplasty patient came to Dr. Thomas Lamperti concerned about a long standing problem with nasal obstruction. He was also dissatisfied with the pinched appearance to his nose along with the hump on his bridge. He also desired improvement to the knob, or bossa, on his left nasal tip. Using an open septorhinoplasy approach Dr. Lamperti deprojected the patient’s tip and gave him a more natural profile. Cartilage spreader grafts were placed to widen the narrowed middle third. Using advanced techniques, the patient’s nasal tip cartilages were repositioned, lending a more open airway and improving his tip pinching and bossa.

Asymmetric, pinched, overprojected tip

This Seattle rhinoplasty patient had concerns regarding her strong profile, dorsal hump and asymmetric tip. Dr. Thomas Lamperti noted that patient had an overprojected,  pinched tip with marked asymmetry of her tip due to a concave left nasal tip cartilage. The patient underwent an open septorhinoplasty, including the placement of septal cartilage grafts, to improve these issues. Shown six months after surgery, one can already note a natural profile and a more symmetric nasal tip. There is an expected amount of fullness to the nose that will continue to improve as the patient’s skin redrapes over her new underlying framework.

Deviated nose with dorsal hump and broad nasal tip

This Seattle rhinoplasty patient had broken her nose a few years prior to seeing Dr. Thomas Lamperti and had noted that her nose now deviated to her left. She besides developing a bump on her bridge in the area of the fracture, the patient also had a newly deviated septum. Dr. Lamperti performed an open septorhinoplasty to straighten the patient’s septum smooth out her bridge (as seen on profile view) and straighten her deviated nasal bones. The patient is shown before and six months after her surgery. We would expect the skin over the patient’s bridge to continue to shrink wrap over the next several months.

Dorsal hump and supra-alar pinching

This Seattle rhinoplasty patient came to Dr. Lamperti noting problems with nasal breathing that had become worse after having a skin cancer removed from his left nasal tip. This cancer excision had led to external nasal valve collapse which hindered his nasal airway opening. Dr. Lamperti was able to correct the collapse in this area and also straightened his septum and bridge. The postoperative photos represent 1 year results.

Deviated nose and broad nasal tip

This Seattle rhinoplasty patient had chronic nasal obstruction and was also concerned about the width and roundedness to her tip and fullness to her bridge. Using an open septorhinoplasty approach, Dr. Lamperti straightened the septum, improved the middle third narrowing, and adjusted the fullness to the bridge. He also refined the tip bulbosity and improved the excess tip width. Lastly, the patient’s ala were narrowed in width given their preoperative excess width. The postoperative photos represent 1 year results.

Dorsal hump and boxy tip

This Kirkland rhinoplasty patient wished to improve his bridge bump and also the boxiness to his nasal tip. The patient underwent an open septorhinoplasty where Dr. Lamperti was able to improve the patient’s tip definition, projection and boxiness. Lower lateral crural strut grafts were used to help refine his bulbous tip. He also refined the profile line by trimming excess tissue from the bridge. The after photos represent 6 month postoperative results.

Cleft Nose repair and Cleft Lip Augmentation

This Seattle rhinoplasty patient had a cleft lip that was repaired as an infant. She came to Dr. Lamperti interested in improving her nasal deviation and difficulty breathing. She was also interested in improving the notched appearance to her upper lip. Dr. Lamperti performed an open septo-rhinoplasty to straighten her septum and external nose. He also de-projected and refined her tip and removed the bump on her bridge. To improve her lip appearance Dr. Lamperti advanced tissue from the inside of the lip and then used soft tissue from behind the patient’s ear to permanently augment the notched area.

Dorsal hump and boxy, overprojected tip

This Seattle rhinoplasty patient came to Dr. Lamperti wishing to reduce the size of her nose. Using an open septorhinoplasty approach the patient’s tip projection and boxiness were reduced while her tip rotation was increased slightly. The internal nasal valve stenosis (or middle third pinching) was improved with cartilage structural grafting using the patient’s septal cartilage. The patient’s profile line was then refined maintaining a non-operated, yet more feminine appearance. One can see how preoperatively the patient’s nose distracted one’s attention, but after surgery it blends more seamlessly with the rest of her face so that one is able to focus on her eyes. The postoperative photographs represent results after 13 months.

Congenital Short Nose Repair

This Seattle rhinoplasty patient came to Dr. Lamperti looking to improve her chronic nasal congestion. Dr. Lamperti also noted her very upturned nose and external nasal deviation that appeared to be congenital. The patient had an open septo-rhinoplasty to straighten her septum and external nose. Dr. Lamperti also lengthened the patient’s nose using a caudal septal extension graft, improving the upturned nature of her tip. You can see how her nose has been lengthened and her nostrils are much less visible.

This Asian Seattle rhinoplasty patient was referred to me to see what could be done about the severe saddle-nose deformity that resulted from his Wegener's granulomatosis. This autoimmune disease leads to chronic blood vessel inflammation which results in compromised blood flow to various parts of the body including the nose. In this patient's case, the cartilage of his nose was among the areas affected. Over time this lead to decreased structural support of his bridge and significant collapse of the dorsum.

We waited until his Wegener's disease was stabilized with medication before performing reconstructive surgery to repair the depressed bridge. The patient didn't have any functional breathing issues so an onlay graft using a layered, custom-carved ear cartilage was used to create a natural, strong dorsal line. The cartilage was placed using a hidden incision inside the right nostril. You can see in the before and 1 year post-operative photos how his severe saddle-nose deformity is now much improved. He now has a natural, strong appearing bridge that shows no evidence of his prior deformity.

Wide, underprojected tip with dorsal hump

This Seattle male rhinoplasty patient came to Dr. Thomas Lamperti with concerns regarding the large bump on the bridge of his nose. Dr. Lamperti noted that the patient had an underprojected, droopy tip that lacked refinement. Using an open septorhinoplasty approach Dr. Lamperti was able to improve the patient’s tip projection while at the same time slightly lifting and narrowing his tip. Using cartilage from the patient’s septum Dr. Lamperti built up the radix (upper part of the nose starting between the eyes) and brought down the remaining bridge to give the patient a strong, masculine profile. The photographs show the patient’s 2 month postoperative result.

Dorsal hump and full, overprojected tip

This Seattle rhinoplasty patient noted a long standing dissatisfaction with her nose. She was especially bothered by the bump on her bridge and rounded nasal tip which appeared disharmonious with the rest of her face. During her consultation Dr. Thomas Lamperti also identified asymmetric narrowing to the left middle third of the patient’s nose along with an overprojected nasal tip. The patient also had a low radix (the root or start of the nose between the eyes) which further exacerbated the appearance of fullness to her bridge. An open rhinoplasty approach was used to refine and deproject the patient’s tip, straighten the nose, smooth the bridge, and place a cartilage graft to the radix. The postoperative photographs represent results after 2 1/2 years.

Nasal deviation and dorsal hump after nasal fracture

This Seattle rhinoplasty patient broke her nose several month prior to seeing Dr. Lamperti. She was interested in improving her deviated nose and the bump on the bridge of her nose. Dr. Lamperti improved the patient’s external deviation while also smoothing out the profile line. To better balance out her facial proportions, Dr. Lamperti also increased the patient’s tip projection slightly. The after photos represent six month postoperative results.

Over-projected tip and dorsal hump combined with chin implant

This Seattle rhinoplastypatient wished to improve the prominence of her nose and decrease the bump on her bridge. Dr. Lamperti identified an underdeveloped chin and recommended a concurrent chin implant to help balance the patient’s facial feautures. The patient is shown before and 6 months after surgery. She can expect additional nasal tip swelling resolution over the next several months.

Post-traumatic alar retraction

This male Seattle rhinoplasty patient injured his nose in an accident several years ago which resulted in a depressed scar in the area just above his right nostril. This pinching, along with a deviated septum, led to chronic difficulties breathing through his nose. On frontal and profile views, one can see how this scarring led to retraction of the patient’s right ala, giving the nose a twisted appearance. Using only hidden incisions Dr. Thomas Lamperti straightened the patient’s septum and using cartilage grafts improved the patient’s alar retraction and pinching. The patient reports that his nasal breathing is remarkably improved. The photographs represent preoperative and 6 week postoperative results.

Dorsal hump and pinched tip

This Seattle rhinoplasty patient wished to improve the bump on her bridge and reduce the natural pinching of her tip. Dr. Lamperti refined the profile line and improved the nasal tip pinching. The patient is shown before and 2 years after surgery.

Dorsal hump and deviated nose after nasal fracture

This Seattle rhinoplasty patient broke her nose several years prior to seeing Dr. Thomas Lamperti and was interested in straightening the nose and improving the bump on her bridge. Dr. Lamperti’s preoperative morphing is shown in the middle pane of the frontal and profile views. On the 13 month postoperative photos on the right pane, one can see that the nose is much straighter, the tip has been de-projected slightly, and the bridge has been smoothed.

Indian Ethnic rhinoplasty with crooked nose and dorsal hump repair

This Seattle rhinoplasty patient came to Dr. Lamperti looking to fix her severely deviated nose which she suffered due to a prior nasal fracture. She was experiencing chronic nasal congestion as a result of the internal and external crookedness. Also as a result of her nasal injury she developed a hump on her bridge which she was also interested in smoothing. Dr. Lamperti was able to refine the patients bridge and reconstruct her severely deviated septum. He also deprojected her tip somewhat and reduced the upturned appearance of her nose by improving the fullness of her infra-tip lobule. In the 1 year postoperative photos you can see how the patient's bridge is much smoother and on frontal view her nose much less deviated. Importantly, the patient is also able to breathe much better as well. 

Rhinoplasty to treat a bulbous nose, dorsal hump, upturned tip and caudal septal deviation.

This Seattle rhinoplasty patient wanted to improve both the appearance and function of her nose. She wanted to refine her rounded nasal tip along with smoothing her bridge. Her breathing was severely affected by a deviated nasal septum that created wildly asymmetric nostrils that you can see in her base view photo. Dr. Lamperti was able to create improved refinement to the tip while also smoothing her nasal bridge. Dr. Lamperti also noted that the patient's tip was upturned so he was able to counter-rotate the tip to provide a more natural tip orientation. In the patient's after photos you can see how the tip appears less wide and the profile line is now nicely smoothed with a less prominent tip. Her columella is also much straighter following the caudal septal reconstruction. Dr. Lamperti also performed facial volumization with skin filler placement to improve the patient's facial fat loss.
 

Bulbous over-rotated nose rhinoplasty and asymmetric nostril repair combined with sinus surgery and dermal filler injection

This Kirkland rhinoplasty patient came to Dr. Lamperti wanting to refine her rounded tip and smooth her profile. She also had significant nasal breathing blockage related to her severely deviated nasal septum which even led to asymmetric nostrils. She also suffered from recurrent sinus infections that she was looking to improve. Separately, this patient wanted to improve her facial volume loss to create a rejuvenated appearance. In analyzing the patient's nose Dr. Lamperti also found that her nasal tip was also somewhat upturned and that lengthening her nose modestly would further improve her nasal appearance. To correct these issues Dr. Lamperti performed an open septorhinoplasty along with sinus surgery. He reconstructed the patient's caudal septum (the part of the septum closest to the nostrils) in order to improve her nostril asymmetry. Dr. Lamperti also repositioned the patient's nasal tip in a less upturned position and also smoothed the bump on her bridge. To refine the bulbous nasal tip a cephalic trim and dome binding sutures were used to flatten the lower lateral cartilages. Dr. Lamperti concurrently performed sinus surgery to open up the patient's blocked cheek and forehead sinuses. In the after photos taken about 1 year after surgery you can see how the tip is more refined while not appearing pinched or overdone. The tip is also less upturned and the bridge bump smoothed. On base view you can see how the crooked columella is now much straighter. The patient reports being able to breathe much better and has much improved sinus function following surgery. Dr. Lamperti also injected dermal filler restylane and radiesse following surgery in order to create a softened, more youthful appearance.

Facial Feminization Rhinoplasty Combined With Functional Breathing Repair

This male to female Seattle facial feminization rhinoplasty patient came to Thomas Lamperti, MD looking to begin the process of facial feminization surgery. Besides wanting to reduce the overall size of her nose she also wanted to improve her chronic nasal congestion problems. Dr. Lamperti noted several issues on initial examination. The patient had a very broad, bulbous tip along with wide nasal bones and a bridge hump. Additionally, the patient had a deviated nasal septum, which was even noted on the patient's base view. Dr. Lamperti performed an open septo-rhinoplasty to address these concerns. First, he reconstructed the patient's deviated septum, creating more even nostrils and much better nasal breathing. Next, Dr. Lamperti smoothed the patient's bridge, removing the patient's nasal hump. A more feminine supratip break was also created. Controlled bone fractures were used to narrow the wide nasal bones. To refine the patient's bulbous tip a cephalic trim and dome binding sutures were used to narrow and flatten the convex lower lateral cartilages. The tip defining points were also narrowed using sutures as well. In the 6 month after photos you can see how a less masculine nasal appearance is seen. The nose is less big and wide overall and there is no longer a prominent bridge hump. The tip is also less prominent and bulbous. You can also see how the columella is straighter on base view following septal reconstruction.

Closed Rhinoplasty With Radix Grafting And Nostril Width Reduction

This Seattle rhinoplasty patient wanted to reduce the size of his nostrils along with augment the upper part of his bridge to address a pseudohump deformity. Dr. Lamperti performed a closed septo-rhinoplasty in which septal cartilage was harvested to then create a radix graft that was inserted at the upper portion of the bridge via a hidden incision inside the patient's nose. Next, Dr. Lamperti performed an alar base wedge excision to subtly reduce the width of the patient's nostrils. In the one year postoperative photos you can see how a more masculine bridge is seen on profile view. The radix graft had the secondary benefit of softening the patient's brow ridge. You can also see on base view how a natural appearing, more narrow nasal tip width is now evident. Lastly, on oblique view you can notice how the alar wedge incision line scar is seemlessly hidden into the patient's alar-facial crease. No staged scar dermabrasion was used.

Asian Rhinoplasty Using Septal Cartilage Bridge Augmentation Grafting

This Seattle Asian Rhinoplasty patient went to see Dr. Lamperti looking to refine her nose and make it look less wide and big. Dr. Lamperti noted a low bridge and wide nostrils in addition to an under-projected nasal tip. Using the patient's septal cartilage, Dr. Lamperti created a customized graft for the patient's bridge augmentation. He also used additional cartilage grafting to improve the patient's tip projection, further refining the appearance of her tip. To improve the patient's wide nostrils, Dr. Lamperti performed an alar base reduction. In the 1 year post-operative photos you can see how the patient's bridge now looks less wide on frontal view. Her tip also appears narrower and more refined. On frontal and profile views you can also see how the patient's tip is less upturned following surgery. She also has less columellar retraction on profile view. On base view you can see how the tip is more projected and how the nostrils are more obliquely oriented following surgery.

Afro-Dominican Ethnic Rhinoplasty To Create Tip Refinement And Narrow Nostrils

This Seattle based Afro-Dominican rhinoplasty patient came to Dr. Lamperti wanting to narrow and refine her bridge, nostrils and tip. She also was concerned with the prominent supra-alar pinching that she naturally had (no prior rhinoplasty as a cause) and wanted to see if that could also be addressed. Dr. Lamperti noted a wide bony upper third of the patient's nose along with wide nostrils and mild alar retraction. Dr. Lamperti performed a closed septorhinoplasty to treat these issues. First, controlled bone fractures were performed to narrow the wide upper nasal bridge. Next, he used harvested septal cartilage to create alar batten grafts which were placed in an onlay fashion over the patient's prominent supra-creases. Lastly, to narrow the patient's wide nostrils a conservative alar base reduction was done using a wedge excision technique. In the approximately 7 month postoperative photos you can see how the patient's wide bridge is nicely narrowed creating an improved brow-tip aesthetic line. The supra alar pinching has also been effaced nicely with just a subtle shadowing now present. You can also see how the batten grafts also acted to subtly reduce the patient's alar retraction as noted especially on profile view. This has resulted in reduce columella show.

Male Rhinoplasty to Narrow Wide Nose With Rounded, Over-Projected Tip with Bridge Hump

This male Seattle rhinoplasty patient came to Thomas Lamperti, MD looking to improve both the overall appearance and function of his nose. He wanted to narrow his wide bridge and tip along with decreasing his tip projection and bridge fullness. Dr. Lamperti performed an open septorhinoplasty surgery in which he straightened the patient's septum. Additionally, he repositioned the patient's tip in a more deprojected and slightly more rotated location. After bringing the tip in Dr. Lamperti also shaved down the patient's bridge hump to match the new tip position. Based on the patient's aesthetic preferences expressed during the office consultation process Dr. Lamperti created a supratip break during this process. The patient also had a full tip along with relatively thick nasal skin. Dr. Lamperti refined the patient's tip using a combination of cephalic trim and dome binding sutures and narrowed the tip defining points using a suturing technique. The wide nasal bones were narrowed using controlled bone fractures (osteotomies) and the nostril width was also reduced using a wedge excision alar base reduction. In the after photos taken about 14 months after sugery you can see how the patient has a more refined tip that is less projecting . The bridge is also less protruding. Given the patient's thick skin Dr. Lamperti would expect the bridge skin to redrape and shrink wrap even more over the following one to two years. Importantly, the patient is also breathing much better.

Septorhinoplasty To Correct An Overprojected, Bifid Tip Along With Valve Stenosis And Septal Deviation

This Everett area rhinoplasty patient came to Dr. Thomas Lamperti to see what options she had in improve her nasal appearance and function. She wanted to refine her tip and make her nose less big overall. Dr. Lamperti noted that the patient had a very long, overprojected, boxy tip with bifid tip cartilages. She also had a crooked nasal septum and columella along with pinching of her internal nasal valve region. Using an open septorhinoplasty technique Dr. Lamperti conservatively (based on patient preferences and limitations or skin redraping) deprojected the patient's tip and refined her profile line. Additionally, he repositioned the patient's tip cartilages so they were in a less trapezoidal configuration. He also performed a septoplasty and placed spreader grafts to improve the patient's nasal airflow. In the 1 year after photos you can see how the patient's tip is more more smooth and triangular and also much less projecting that before. The tip bifidity is no longer present as well. The patient's internal valves are better supported and her columella is also straighter creating more symmetric nostril sizes.

Rhinoplasty To Lenghten A Naturally Short Nose With Wide Nostrils

This Seattle rhinoplasty patient came to Thomas Lamperti, MD to see if she could have her upturned nose made more downturned so that her nostrils were less visible from the front. She was also interested in making her nostrils less wide. The patient had no prior surgery or trauma. Dr. Lamperti noted that the patient had a significantly over-rotated nasal tip as best seen on profile view. Based on the patient's current nostril width Dr. Lamperti predicted that with repositioning her nasal tip downward she would end up with increased nostril flare such that a nostril base reduction was recommended. He also noted a wide bridge that he treated using controlled bone fractures. In the 2.5 year postoperative photos you can see how the patient's tip is much more elegantly positioned creating an overall longer nasal appearance. On fronal view you can also see how you can't see as much of the patient's nostrils The patient's nostril reduction has also healed seamlessly with a natural appearing nostril width.

Female Asian Rhinoplasty To Project a Flattened Tip, Narrow Wide Nostrils and Smooth a Bride Bump

This Korean-American rhinoplasty patient came to Dr. Lamperti looking to refine her rounded, flattened nasal tip along with narrowing her nostril width and smoothing the bump on her bridge. Dr. Lamperti noted that the patient had relatively thick nasal tip skin along with an underprojected tip which created additional tip fullness. Dr. Lamperti performed an open septo-rhinoplasty procedure to made the desired changes to the patient's nose. He first straightened the patient's crooked nasal septum. He then used some of the patient's septal cartilage to form an extended columellar strut which allow Dr. Lamperti to reposition the patient's nasal tip in a more projected position. Dr. Lamperti also thinned the patient's thick nasal tip skin by using a defatting technique. (You can see an intra-operative video of this nasal tip skin defatting procedure here.) To smooth the patient's bridge bump Dr. Lamperti used a rasp to remove some excess bone. Lastly, Dr. Lamperti used a Y to V alar base reduction technique to conservatively narrow the patient's wide nostrils. In the 20 month postoperative photos you can see how the patient's tip has much better definition along with having a smoother bridge. The patient would be expected to have further external nasal swelling reduction as her nose continues to heal.

Boxy and Bifid Tip Rhinoplasty

This Olympia rhinoplasty patient consulted with Thomas Lamperti, MD regarding her desire to achieve a more refined, narrow nose along with improving her chronic nasal obstruction and recurrent sinus infections. During the initial consultation Dr. Lamperti noted that the patient had a wide boney upper nasal bridge along with an overly rounded, boxy, bifid nasal tip. The patient also was interested in narrowing her nostril width conservatively as well. The patient's internal nasal examination also showed that she had a significantly crooked nasal septum and a sinus CT scan indicated narrowed sinus openings contributing to her recurrent sinus infections. Dr. Lamperti performed an open septorhinoplasty and sinus surgery to correct the patient's septal deviation and sinus drainage blockage. He also smoothed down the patient's bridge creating a more feminine appearance. To narrow the nasal bones a combination of lateral and intermediate osteotomies were placed. Additionaly, Dr. Lamperti refined the patient's tip by performing a cephalic trim and placing dome binding sutures. He narrowed the patient's wide, boxy tip defining points and effaced the bifidity in this area by placing an interdomal suture to narrow the distance between the nasal domes. Lastly, Dr. Lamperti performed a conservative nostril reduction using a Y-V advancement technique in which the nostrils were moved inward 3 mm on each side. In the 14 month after photos you can see how the patient now has a very natural, but refined appearing nose with a more narrowed overall appearance. You can also see how her tip no longer has its original bifidity and has nice smooth transitions from the tip to the ala and bridge. Importantly, the patient's nasal breathing and recurrent sinusitis symptoms are greatly improved.

Facial Feminization Rhinoplasty Before And After

This Seattle feminization rhinoplasty patient consulted with Thomas Lamperti, MD to see what could be done to make her facial features more feminine. Over the course of a few procedures the patient opted to have direct brow lift, mini-facelift, upper lip lift, facial fat transfer and rhinoplasty surgery. The patient's original nose was quite masculine due to the large bridge bump, especially. The patient's rhinoplasty involved an open approach in which the bridge was smoothed down, the nasal bones made less wide and the tip made less projecting. In the 1 year after photos you can see how the patient now has a much smaller nose overall. She also has a more refined bridge with a slight concavity. You can also see how the patient's tip is less projected and the columellar base less full as well. This effect was achieved after smoothing the posterior septal angle.

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 the 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 prioro 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 also done to narrow and refine the patient's bridge width as well. 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 as well. 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 agressive 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.

Saddle Nose Deformity Repair with Rhinoplasty and Septal Cartilage Grafting

This Renton rhinoplasty patient had suffered prior, untreated nasal fractures which had left him with a boxer's nose (saddle nose) deformity. This resulted in a collapsed nasal bridge in the area below his nasal bones. He also had a somewhat droopy tip. Inside his nose the patient also had a deviated septum which created blocked nasal breathing. Thomas Lamperti, MD was able to rebuild the patient's bridge and straighten his septum using an open septorhinoplasty approach. Dr. Lamperti built up the patient's bridge using a multi-layer, laminated septal cartilage graft. He also slightly lift the tip so it wasn't droopy anymore. In the 2 month after photos your can see how the patient now has a much straighter bridge on profile view and a reduced broad shadow on frontal view. His tip is less droopy yet still maintains a masculine appearance. Importantly, the patient also reports much improved nasal breathing.

Functional Septorhinoplasty Combined with Sliding Genioplasty and Necklift and Neck Liposuction

This Seattle rhinoplasty patient noted many years of chronic nasal obstruction and snoring. During his office exam Dr. Lamperti noted that the patient had a deviated nasal septum along with internal and external valve nasal stenosis which were all restricting the patient's nasal airflow. To correct these problems a functional septorhinoplasty was performed to straighten the patient's septum. Additionally, spreader grafts were placed to treat the patient's collapse middle bridge area (internal nasal valve) and lower lateral crural strut grafts were placed to rebuild the patient's pinched nostril region (external nasal valves). You can also see how the patient had a droopy tip prior to surgery and this was conservatively corrected during the rhinoplasty. Careful attention is required during this process so as not to create an over-rotated, feminine tip. Sliding genioplasty, neck liposuction and corset platysmaplasty were done during the same surgery to address the patient's other treatment goals. In the 1 year after photos you can see how the patient has mantained a natural appearing nose that no longer has the same pinching and cartilage collapse. His neck and jawline are also much more proportional and masculine. Thanks to his improved airway, the patient has reports much improved snoring as well!

Combined Rhinoplasty with Silicone Chin Implantation and Mandibular Angle Filler Injection

This Seattle chin implant and rhinoplasty patient was interested in smoothing his bridge bump and reducing the bulbosity of his nasal tip while making his nose smaller overall. Additionally, he wanted to create a stronger jawline and improve his recessed chin. Using an open septorhinoplasty approach Dr. Lamperti straightened the patient's crooked septum (including the caudal strut which was creating a crooked tip). He also smoothed down the patient's bridge hump while maintaining a strong bridge. Bilateral spreader grafts were placed to support the middle third of the patient's bridge following the hump reduction and to address the pre-existing pinching in this area. To refine the patient's rounded, boxy tip Dr. Lamperti performed a cephalic trim and dome binding suturing. He also reduced the interdomal distance between the nasal tip cartilages using an interdonal suture. The patient also had wide nostrils so Dr. Lamperti performed an alar base reduction using a wedge excision technique. In the preliminary 6 month after photos you can see how the patient now has a more smooth bridge and refined tip (still with some expected skin swelling present at this stage) along with a narrower nostril width and improved tip boxiness. You can also see how the spreader grafts have created a more seamless brow tip aesthetic line with no more middle third narrowing. You can learn more about this patient's chin implant surgery here.

Droopy Tip With Bridge Bump Rhinoplasty

This patient was looking to smooth her bridge bump and refine her tip with rhinoplasty surgery. She travelled to Seattle to see Dr. Lamperti to find out what her options were. Dr. Lamperti noted that the patient's tip was a bit droopy and that her bridge had a significant bump. He recommended an open septorhinoplasty surgery to address the patient's concerns. In the 10 month after photos you can see how the patient's tip has been conservatively elevated so it isn't so downturned. Also you can appreciate her smooth, natural appearing bridge.

Saddlenose Deformity And Bride Hump Removal Septorhinoplasty Repair

This Seattle rhinoplasty patient came to Dr. Lamperti to improve the appearance of her bridge which had a large hump and sunken area. She also had chronic nasal obstruction related to a crooked septum. She had injured her nose several times in the past several which likely led to her nasal problems. Thomas Lamperti, MD noted a saddle nose deformity related to collapsed cartilage in the supratip region. He also noted a deviated septum and bridge hump. Using an open septorhinoplasty approach Dr. Lamperti smoothed down the patient's bridge hump and built up the saddle nose deformity. He also straightened the patient's septum. The after photos were taken just 3 months after surgery so there is still swelling in the patient's nose (especially in her tip) but you can see how her bridge is much smoother. She also notes improved breathing thanks to the septoplasty surgery.