This website uses its own and third party cookies to provide a better service. If you continue to browse, you are deemed to have accepted their use. See our Cookies Policy and Legal Notice and Terms of Service
PROMOTIONS: Check discounts from our Combo Specials and Day Specials. We implement the Safe Surgery protocol to offer maximum guarantees.

This revision rhinoplasty case was featured by the abundant fibrosis due to poor technical gestures of aggressive kind after several previous closed rhinoplasties; the fibrosis had to be meticulously removed in order to indentify the extent of the damage and which parts were viable, so that a final reconstructive strategy would be suitable planned.

READ
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 1
#1Very abundant fibrosis, a typical sign of lack of technical refinement and aggressive surgical gestures; it makes impossible simple identification of structures at first glance, making the dissection terribly tedious and slow, dangerous to the ...Read more
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 2
#2The arrows point to severed fragments of the left lateral crura, entangled with a mass of post ischemic fibrosis; the left dome is at this point non visible; the right crura is clearly seen and at this point is unclear its damage.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 3
#3Fragment of the left lateral crura; this is not viable or reparable, thus will have to be removed.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 4
#4Iatrogenic transection of the right lateral crura is found; seems it was accidentally torn or cut during one of the previous rhinoplasties.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 5
#5Comprehensive vision of the massive fibrosis, which produced a preoperative appearance of well supported nose but actually it was not at all; this is a good example of how tricky and unpredictable revision rhinoplasties can be, the surgeon can ...Read more
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 6
#6Very clearly the arrow points the location of the right crura transection.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 7
#7This lateral crura was severed and evidently became one of the technical requirements of the case.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 8
#8After a very delicate and tedious debridement of fibrosis finally both lateral and both medial cruras were freed and clean, allowing understanding of the underlying problems; the right one could be saved by only its inner 30%, the rest was shattered ...Read more
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 9
#9The arrows point the crushed area of the left lateral crura and a fracture at its dome, totally non supportive and lacking any structural role; the medial cruras were in an acceptable condition; the left crura was left in a small valid portion.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 10
#10The lateral cruras were deemed irreparable in view of their damage, evident in this image.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 11
#11The right lateral crura had been accidentally damaged at this point.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 12
#12Fracture and weakening of the left lateral crura.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 13
#13The weakness and crushing of the left lateral crura can be seen here.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 14
#14Damage of both lateral cruras and in between them the septum looks weak and lopsided, also damaged.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 15
#15Multiple damages to the alar cartilages.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 16
#16Only the medial cruras could be saved; the rest needed full rebuild.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 17
#17The right ear donor site; the posterior access allows a hidden scar behind the auricle; the crus of the helix is essential for the ear support and has to be preserved; the areas that can be safely harvested are the upper concha fossa or cymba ...Read more
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 18
#18The cartilage portions harvested are shown in correspondence with the anatomical creases and fossae were they do belong to; the helix crus is firmly supporting the ear as a beam; note how the helix and antihelix creases are not deformed or distorted ...Read more
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 19
#19Rear view of the left ear donor frames of cartilage; harvesting cartilage from the ear is not a trivial or simple maneuver at all.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 20
#20Left ear anterior vision showing the harvested cymba y cavum fossae; now the surgeon has to close the donor sites and carry out the customization, tailoring and shaping of the new structural elements to fit in the newly planned nasal shape.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 21
#21Arrows point at the junction of the saved medial cruras and the handmade new lateral cruras which will support the alae and the tip, also provide nasal valve support to breathe properly.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 22
#22The new lateral cruras, made our from ear cartilage, are meticulously sutured to the remains of the medial cruras and fit into new pockets under the nostril rims.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 23
#23Full repair of the lateral cruras, the tissue looks now healthy and supportive.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 24
#24Detailed vision of the septal lengthening maneuver; due to the shortage of caudal septum and the deemed need of strong caudal and anterior nasal support it was opted by a two on two septocolumellar L shaped grafts design; two caudal extension ...Read more
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 25
#25Two caudal and two vertical extension grafts allow at the same time nasal lengthening and tip reprojection.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 26
#26Note how the septum and the whole nose has been massively lengthened and resupported, as well as the tip lengthened and reprojected; the arrows point at the junction of the grafted lateral cruras.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 27
#27Perfect nasal shape, alignment of the L shaped septocolumellar grafts and optimal columellar support; the arrow points to the fully horizontal columella.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 28
#28Contralateral view of the septocolumellar grafts; two within and two outside.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 29
#29 The original medial cruras and the newly made lateral cruras are firmly suture to the angle of the septocolumellar grafts, obtaining thus perfect location, derotation, lowering, projection and shape, by means of a tongue in groove maneuver.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 30
#30The nose has been lengthened and reconstructed.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 31
#31Perfect angulation of the new nasal skeleton.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 32
#32The tip is made out of an auricular cartilage graft, suitable customized and firmly sutured on top of the peak of the new nasal skeleton.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 33
#33Great care is take to apply the right location and the perfect angle to the shield graft forming the new tip; it is noticeable the firm support and the healthy look of the new nose.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 34
#34Nasal tip properly located and pushed down and forward by the grafts applied.
Broad nose,Bulbous tip,Crooked nose,Crooked tip,Droopy tip,Nasal fibrosis,Nasal valve collapse,Overrotated tip,Parenthesis tip deformity,Pinched middle vault,Pinched nose,Plunging tip deformity,Poorly defined tip,Poorly supported tip,Rounded tip,Short nose,Short septum,Short upper lateral cartilages,Small alar cartilages,Sunken columella,Tip bossae,Underprojected tip,Alar contour rim graft,Columella lengthening,Columella strut graft,Custom made tip graft,Ear cartilage graft harvesting,Extended columella strut graft,Intercrural columella plasty sutures,Interdomal tip plasty sutures,Lateral cruras custom made graft,Lateral cruras replacement graft,Lateral cruras repositioning,Open approach incision,Septocolumella graft,Septum caudal extension graft,Septum replacement graft,Shield tip graft,Spreader graft,Tip defatting,Tip replacement graft,Tongue in groove columella setback - photo 35
#35Final look from below; the time consuming revision procedure ends with a very successful achievement of a new optimal structure; they are not visible in the images but dorsal hump regularization an nasal bones osteotomies were performed.

  RATE THIS CASE FOR THE COMMUNITY

How much did you like the case?
How much has been useful to you?
Ranking
Usefulness
Popularity

  TECHNICALITIES

  • AREAS

  • TREATMENTS

    Reconstruction Rhinoplasty
    Revision Rhinoplasty
    Structure Rhinoplasty
  • DIAGNOSES APPLICABLE

    Broad nose
    Bulbous tip
    Crooked nose
    Crooked tip
    Droopy tip
    Nasal fibrosis
    Nasal valve collapse
    Overrotated tip
    Parenthesis tip deformity
    Pinched middle vault
    Pinched nose
    Plunging tip deformity
    Poorly defined tip
    Poorly supported tip
    Rounded tip
    Short nose
    Short septum
    Short upper lateral cartilages
    Small alar cartilages
    Sunken columella
    Tip bossae
    Underprojected tip
  • TECHNIQUES EMPLOYED

    Alar contour rim graft
    Columella lengthening
    Columella strut graft
    Custom made tip graft
    Ear cartilage graft harvesting
    Extended columella strut graft
    Intercrural columella plasty sutures
    Interdomal tip plasty sutures
    Lateral cruras custom made graft
    Lateral cruras replacement graft
    Lateral cruras repositioning
    Open approach incision
    Septocolumella graft
    Septum caudal extension graft
    Septum replacement graft
    Shield tip graft
    Spreader graft
    Tip defatting
    Tip replacement graft
    Tongue in groove columella setback

  DR. ALEJANDRO NOGUEIRA'S SIMILAR CASES PHOTO GALLERY *

  CONTACT US

  DISCLAIMER

  • This information is indicative only and does not represent an obligation with patients or a prediction of forthcoming events, since is based on statistical means for large groups of patients, with the variability that implies, and the biased experience of medical professionals.
  • Medicine and Surgery are not exact sciences, therefore it is not possible to foretell the most likely evolution neither establish the most suitable management for each individual case until the moment the physicians can preoperatively evaluate the patient and receive feedback about the postoperative.
  • One surgical process can't be fully predictable or be rigidly scheduled on a previous protocol, so the management plan may be modified at any time based on the requirements that could be considered as necessary or most suitable.
  • Healing is an imprecise and always unpredictable process due to the uniqueness nature of each patient; even with your physician prioritising post-op patient care excellence and scar minimisation techniques and treatments your evolution and results may be likely different to the information contained on this website, therefore your physician cannot guarantee any specific scenario and outcome commitment regarding your procedures.
  • Remember that all surgery is likely to produce lasting swelling and a lifetime permanent scar, which is likely to partially evolve over approximately 12 to 18 months or longer because this is an issue of unpredictable kind; some patients may be prone to permanent swelling and bad scarring.
  • Information on our website is not a substitute for a personalised, individual consultation that includes a physical examination, history taking, a discussion of the potential risks including potential common complications, pros and cons of various procedural options, and the likely outcome expectations of your surgical procedure. Only an in-person consultation and examination can help your physician to provide you with information about what you, personally, as a unique individual, can expect.
  • Dr. Alejandro Nogueira's opinions, indications, procedures, techniques and methods of diagnosis, treatment and management change frequently as new information is available due to scientific knowledge and state-of-the-art medical practice progress; we aim to keep information updated, but it is possible that some information may have been superseded and is in process of being added to our website, therefore it may not represent Dr. Alejandro Nogueira's most current methods or protocols.
  • All images are genuine, trustworthy and real standard views of the "before" situation and the long term settled "after" actual results of Dr. Alejandro Nogueira’s work, as well as true intraoperative surgical views and authentic technical or clinical scenarios depicting real practice hands-on cases belonging to Dr. Alejandro Nogueira's skills and expertise.
  • No other professional but Dr. Alejandro Nogueira himself as leading and executing surgeon has carried out the techniques, procedures and surgeries shown in the galleries.
  • No images were staged, digitally edited or modified in any way, except for cropping, adjusting and resizing to fit gallery format, removing identifiable elements and blanking with anonymity purposes.
  • The images of results, treatments, techniques and clinical situations are mere guidance examples aiming to help the patients in their decision-making process, providing an average overview of Dr. Alejandro Nogueira's work; no one of them can be considered as an obligation of any particular results nor a commitment for the application of any specific techniques, therefore you should not base your results expectations on them.
  • Every patient has to be assessed individually in order to establish a customized prognosis of results and design an individual surgical plan, being somehow unpredictable the real final outcome of any procedure as well the surgical gestures applied during the intervention, since they will depend on multiple particular, frequently unpredictable and sometimes uncontrollable factors.
  • Even when you feel that you look very similar to another patient in their images, your results will likely vary significantly, because you are a unique person and every individual has not only a completely unique physique, but also uniquely individualistic body healing capacities, scarring tendencies and recovery processes, some of which are unpredictable even in very-healthy patients who rest adequately and do all the other right and prescribed things before and after their procedure.
  • Previous successful results of a physician do not guarantee future successful procedures and patient's satisfaction.
  • The images may display content that is graphic in nature showing explicit surgery, clinical events and that may depict partial or total nudity; if you find such material offensive or you are sensitive to it you should not use this feature and should exercise caution before accessing other explicit features of the website.
  • The images are appropriate for a mature-only audience; if you are under the age of 18 you should not view the content of this website.
  • All the prices and quotations visible on our website belong to or are calculated out of the reduced price list and do already enjoy by default a -20% discount from the standard price list for our treatments as compensating remuneration for the release and transfer of the intellectual property, the rights of image, the medical records and the personal data of our patients for scientific dissemination, medical teaching, public communication, commercial promotion, advertising marketing, commercial exploitation and disclosure in general, unless they express the opposite at their surgery day booking by opting for the standard prices. External Link READ MORE ABOUT BENEFITS OF THE COLLABORATIVE MODEL
  • Our prices are quotations valid for the majority of cases operated on; notwithstanding a few cases are non standard, atypical, requiring exceptional resources and, therefore, needing customized quote calculation; do seek the advice of our Medical and Sales Teams to find out whether your case lies within the standard protocol of management, which actually is the most likely scenario.
  • Standard quotations do cover the planned protocol of management, including preoperative consultation with the surgeon, preanesthesia examination, basic preoperative tests, surgeon, anesthetist and assistant fees, planned operating room, rental time, regular intraoperative surgical supplies (materials, drugs, etc.), agreed implants (breast, etc.), one recommended postoperative garment (brassiere, corset, etc.), 1 hour recovery unit stay, individual ward room, regular hospital supplies (materials, drugs, etc.) and postoperative office-based care.
  • Not included in standard quotations are, among others, non basic preoperative tests, pre and postoperative consultant referrals for assessment, additional garments, non hospital supplies (materials, drugs, etc.), postoperative tests and any kind of postoperative re-interventions, postoperative medical or surgical emergencies and costs exceeding the planned protocol of management like unplanned, unforeseeable and unavoidable extended surgical time rental of the operating room, extended hospital stay in standard ward or Intensive Care Unit (ICU) room and all the associated costs with any hospital-based assistance of complications, medicalized repatriation, hostelry accommodation, maintenance and travel costs; we do not take account of any costs not within the scheduled treatment pre and postoperative planned and agreed management.
  • We do not offer trip packages; the patient is bound to organize and pay for any trip, accommodation, food, transport, etc.
  • Prices do include the V.A.T.
  • Prices do not include any kind of travel or revision insurance; do read about the Surgery Shield for revision surgery here should you wish to be covered in such a case.
  • Treatments are payable in Euros only; we do not accept other currencies as payment of the treatments.
  • Any currency conversion is non accurate and has indicative purposes only.
  • Combo Specials discounts are percentages of reduction applied on the retail price of the standard quotations for the treatments of the price list; these discounts are not applicable on non standard cases, customized quotations and charges not included in the standard quotations.
  • The treatments Breast implants custom XL or Breast reconstruction autologous and the Surgery Shield for any body area treament is expressly excluded from any price reduction, discount and promotion, among them the Combo Specials.
  • Combo Specials are applied and calculated for each purchase of treatments to be performed simultaneously; Combo Specials are not allowed on treatments to be performed in different anesthetic procedures or different surgical episodes; any given purchase of treatments to be performed simultaneously may include more than one Combo Special.
  • One given treatment cannot be affected by more than one discount, be it Combo Specials or other discounts; in the event of a conflict due to the coincidence of more than one Combo Specials discount affecting a given treatment, the discount that produces the greatest gross discount in favor of the patient calculated at the given treatment in conflict level will be applied.
  • The marbellia's General Combo Special only applies to treatments other than those affected by treatment-specific Combo Specials at any given purchase of treatments to be performed simultaneously; for the calculation of the marbellia's General Combo Special all the treatments affected by treatment-specific Combo Specials are considered a single treatment.
  • Any urgent matter of medical or commercial kind must be addressed through our Telephone Assistance which is operative 24/7/365 to contact with the Medical Team or through our Telephone Support which is available in office hours to contact with the Sales Team.
  • Priority but non urgent medical or commercial assistance is available by selecting priority option in the corresponding Online Consultation or Customer Support form.
  • Non urgent and non priority medical consultations may be carried out using the regular Online Consultation or Customer Support form without priority selection.
  • To apply for a face-to-face medical meeting use the In Person Consultation form.
  • If you wish to apply for treatment dates use the Surgery Day Booking form.