What would you do to help my overly-narrowed nose in a revision?

Question

Had my primay rhinoplasty 15 months ago. I've been diagnosed with bilateral nasal valve collapse, nasal obstruction, inverted v deformity, pinched tip, over projection, overresected dorsum, deviated septum, concha bollosa, hypertrophic inferior turbinates. Ive been told I need repeat osteomies, spreader grafts, dcf graft, alar rim grafts, fascia grafts. Im concered that its not possible to get an improvement in my overly narrow bony nasal base and nostrils. Thanks for your time.

William Portuese, MD · Answer

A closed rhinoplasty approach can accomplish a small amount of de-projection, and de-rotation along with tucking in the hanging columella. Spreader grafts placed underneath the concave upper lateral cartilages will give you more width to the midportion of the nose. From these photos presented, you don't need alar rim graphs. Osteotomies only make your bridge line more narrow. A septoplasty and turbinate surgery may be required for nasal obstruction, but only after a thorough internal examination of the nose.

What would you do to help my overly-narrowed nose in a revision?

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