Third Revision Masculinizing Rhinoplasty for Nasal Dorsum Collapse and Nasal Deformity
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The patient, who had previously undergone rhinoplasty twice at a different clinic, presented to our clinic complaining of nasal dorsum collapse, asymmetry, and difficulty breathing through the nose. Examination revealed the following findings:
- Deviation of the nasal axis to the right
- Excessively curved nasal profile due to over-reduction of the nasal hump
- "Polly-beak" deformity
- Drooping nasal tip
- Asymmetry between the nostrils
- Collapse of the left nostril during inspiration
We performed an open-technique augmentation revision rhinoplasty.
Operative note: Following a columellar incision, the nasal tip skin was elevated. Caudal septoplasty was performed. The dome points of the alar cartilages were repositioned. Nasal tip cartilage support was enhanced by placing a septal extension graft using the "tongue-in-groove" technique. A left marginal rim graft and a cap graft were placed. Irregularities on the nasal dorsum were corrected using a micromotor with a tungsten burr. Bilateral low-to-high osteotomies were performed using an ultrasonic device. A left spreader graft was placed. A fascia graft harvested from the right temporal region was placed—in a butterfly shape—over the pre-marked areas to augment the nasal dorsum. The skin was redraped and sutured. Bilateral internal silicone splints were inserted, and the nose was taped. Additional note: The patient presented with a nose shape that appeared feminine. He reported significant wrinkling on the nasal dorsum when smiling (due to excess skin resulting from over-reduction of the nasal hump), a downward drooping of the nasal tip during smiling, and a curved profile that was disproportionate to his face. The procedure aimed to restore a masculine appearance and normalize the nasal shape by augmenting the nasal hump and enhancing tip support to return the nasal tip to characteristics typical of a male nose. A comparison of the patient's pre- and post-operative images reveals that the nasal shape has become natural and more symmetrical.
This case serves as a typical example of natural male revision rhinoplasty.
Advantages of Using Fascia Grafts in Augmentation Revision Rhinoplasty
In cases where the nasal hump has been excessively reduced, we aim to use a graft that can naturally restore volume to the nasal dorsum. The characteristics of an ideal graft include:
- being a viable (living) graft that does not increase the risk of infection or necrosis in an area where surgical dissection has previously occurred and blood supply is compromised
- the ability to smooth out irregularities on the nasal dorsum
- not causing protrusions or sharp, asymmetrical edges on the nasal dorsum after the resolution of edema
- ease of harvesting
- ease of fixation within the surgical site without shifting. Considering these factors, "fascia" grafts—derived from the connective tissue covering muscles—can be easily harvested and utilized in revision rhinoplasty operations, serving both for augmentation purposes and as a camouflage layer beneath the skin. When block cartilage, diced cartilage, and other cartilage grafts are placed on the nasal dorsum, they may result in surface irregularities or an asymmetrical appearance after healing. On this website, you can find images of various complications arising from the placement of synthetic industrial products on the nasal bridge.
The patient's silicone splints were removed after one week, and the nose was re-taped.
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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon
Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
Appointment Phone: +90 212 561 00 52
Fax: +90 212 542 74 47
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