Primary

This patient presents a combination—quite common—of radix deficiency, a dorsal hump that is both true and “apparent” (that is, accentuated by the depression at the nasal root and by the insufficient projection of the tip), and a weak, poorly supported tip. A significant breathing impairment is also present, as clearly shown on CT. Once again, the key in this rhinoseptoplasty is to address all the interdependent and interconnected components of the nose and to restore correct proportions by appropriately filling the radix deficiency, reducing the hump as needed, and adequately supporting and projecting the tip. Cartilage grafts harvested from the septum will be essential, as well as temporalis fascia for radix augmentation.

In the frontal view, only moderate “refinement” (restructuring) of the tip is visible. The nasal bones in this case should not undergo osteotomy: narrowing them would be aesthetically inappropriate for a male nose and would also pose functional risks.

More than one year after surgery, the tip is better supported, more triangularized, and more harmonious. The columellar scar is no longer visible.

In the three-quarter view, the improvement in proportions between radix, dorsum, and tip is clear and consistent with what is desirable in a male nose. The tip was stably projected with a septal extension graft, in addition to the tip-defining technique known as lateral crura steal.

On profile view, the tip was supported and the radix elevated with a temporalis fascia graft. The dorsum was reduced incrementally until achieving, in this case, a slightly convex profile. Although not perfectly straight, the resulting profile is well suited to the patient’s facial features.

The tip, which preoperatively descended even more when smiling, now remains properly projected, providing significantly improved facial harmony.

On CT, a marked posterior deviation of the nasal septum is evident, accompanied by a bony spur.