Secondary

This patient was affected by a cleft lip and palate, a congenital deformity that also causes nasal deformity. For this reason, in addition to the procedures related to the cleft, she has undergone two previous operations on the nasal pyramid, including septoplasty. Although there has been improvement, the patient complains of residual asymmetry of the left nasal ala, as well as deformity in the three-quarter views and a residual pollybeak deformity on profile. Because there was not enough material available from the septum, the procedure required rib harvesting to obtain appropriate laminar segments to be used as grafts in order to restore, as far as possible, symmetry of the dorsum and tip.

At 12 months after surgery, the nasal pyramid appears aligned with the midline and sufficiently symmetrical. The left nasal ala has also markedly improved in its symmetry compared with the right, although an unavoidable difference remains.

On the base view, the tip appears triangularized, with adequate symmetry despite the evidence of the congenital cleft on the left side.

In the three-quarter views, the nose appears more balanced.

On profile, the dorsum has an appropriate height, with a distinct tip break that defines the transition to the tip. In practice, the tip has been raised concomitantly with correction of the convexity of the pollybeak deformity. The dorsum has been made uniformly smooth throughout with a folded perichondrial and temporalis fascia graft.

In the three-quarter views, the nose appears more balanced.

The scar from rib harvesting in the inframammary fold is practically invisible.