Male Voice: So, I make an incision, and then with my finger, I feed the skin, and I slowly kind of get the knife to slide up to the top. Then, I go back on the other side, and again with the knife, I slide up, so all the way up here, just with the knife. This is all freed up. Then, I take a Q-tip. With a Q-tip, within the right plain, we don't need any kind of cautery. This is all the way up to the cartilage. Coddle, please. Got it.

Then, on the bony part, you want to go subperiosteal. So, I go under the periosteal. And now, I'm up to back here. You free up the coverage. Now, everything is free.

There's different types of wraps, and what we're going to do . . . We're going to slide up here and start gently wrapping the nose. Debris comes off of it. Then, I feel it. Sometimes, with the local, it gets a little heavy. The skin gets thicker. So, you go by feel.

You go to the heavier sucker, 10. Fifteen please, fresh. Come in the [inaudible:00:02:14] [inaudible:00:02:16]. Save this. Grab [inaudible:00:02:51]. You're going to have to grab her from that side if you want to kind of show . . . Bring your hands straight down. You can see how [inaudible:00:03:12] bumps gone now. When we narrow this, it's going to raise it up a little bit more. So, we're going to narrow it, and then plant two and see how much is left.

I put a couple of drops, not a lot, and then the gold handlebars. So, I'm putting the local right where I'm going to do an osteotomy. Lidocaine, 1%, and then make an opening at the vestibule. Coddle, please. Take this end, and I slide on top of the bone, all the way through back here, lifting everything off, so you don't nick the angular vessels.

Each time we use this . . . You can show this if you want. I sharpen the osteotomes so that they're really nice and sharp. That's that.

Male Voice: You low to high?

Male Voice: Yeah. That's it. There it is.

Female Voice: Is that all right?

Female Voice: Yeah, that's fine.

Male Voice: High, low, high.

Male Voice: What's that?

Male Voice: I start high. High, low, high.

Male Voice: Oh. Do you?

Male Voice: Yeah. That way, I'm leaving a little edge of bone right at the head of the [inaudible:00:05:03]. So, you don't medialize that and create a nasal obstruction. Okay. One starting this way, and then I'll drop the angle down.

Male Voice: Wet one, please.

Male Voice: Want a piece of cartilage from her septum. Goes in here. [inaudible:00:06:05]. Going to go right here. Look right there. Remember how we said there was an area of weakness there before? I filled that. [inaudible:00:06:42] Then, go to the side. Drop your hands here, like level. You can see [inaudible:00:06:51] more.

Male Voice: [inaudible:00:06:56].

Male Voice: This is hard now. Pre-op. Post op, mont one.

Closed Septoplasty and Rhinoplasty (Part 2)

The septum is filed to create a straighter, more symmetrical nose for the patient.

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