This patient previously underwent a closed rhinoplasty. In the photographs, the absence of aesthetic lines of the dorsum is evident, as well as an amorphous, downward-tending tip. On palpation—less apparent in the photos—there is a clear irregularity of the dorsum resulting from rasping of the dorsal hump. Clinical examination also reveals left-sided breathing impairment, later confirmed on CT by a residual deviation (left unaddressed during the initial operation).

In this young patient, who has high expectations and naturally harmonious facial proportions, the goal of secondary rhinoplasty is to restore proper aesthetic lines in the frontal view and achieve a well-projected, more refined tip relative to the dorsum. This requires precise restructuring of both the dorsum and the tip. Because the septum is completely intact (although deviated), septoplasty allows for both correction of the deviation—and therefore improvement in nasal breathing—and harvesting of the cartilage grafts needed for the dorsum and especially for the tip.