Primary

The nose here is long and deviated to the right, with asymmetric dorsal aesthetic lines. The tip is bulbous, with a central depression highlighted by the contour of the two alar cartilages, which are particularly strong. The skin is thin. In the profile view, a mild osteocartilaginous dorsal hump is visible which, together with a certain degree of tip ptosis, creates an impression of early “aging.” In this patient, whose face has highly pleasant proportions and contours, the nose draws noticeable attention away from the harmony of the forehead, eyes, and mouth. This is once again a refined structural rhinoplasty, requiring careful balancing of the different components. The tip will be shortened and supported with cartilage grafts harvested from the septum, then refined using the same cartilage components removed from the “bulbous” portion. The dorsum will be reduced incrementally, millimeter by millimeter, until the desired profile is achieved. Given the thin skin, a fascia graft will be placed over the dorsum to prevent imperfections and irregularities.

The dorsal lines have been improved. The tip asymmetries and the deviation have been corrected.

The tip is now triangular. The bulbosity and the central depression between the two alar cartilages have been corrected. The columellar scar is virtually invisible.

In the three-quarter views, the corrected nasal proportions enhance the naturally pleasant balance of the patient’s facial features. Assessing both three-quarter views is critically important in evaluating the real outcome of a rhinoplasty.

The profile is harmonious and natural, with a smooth, uniform dorsum, above which the tip projects only a few millimeters.

In the top view, the harmony of the dorsal aesthetic lines has been restored, and the deviation corrected.

On CT imaging, both the septal deviation and the “concha bullosa” of the middle turbinate are clearly visible. Both were addressed during the procedure. For Dr. Robotti, CT represents the radiologic gold standard prior to performing a rhinoplasty.