This lady had originally sought reduction and refinement of her nose and had undergone rhinoplasty 6 years earlier and a further operation with ear cartilage graft 4 years after that, before seeing me. She had sought opinions about further surgery worldwide. Her concerns were that her nose lacked refinement, was thicker, shorter and wider than her aims. In addition the tip was rounded and ill-defined with nostril retraction and descent particularly on smiling. She also suffered from constant running of her nose and a bad smell intermittently.

The operative side view shows a short deviated septum (yellow arrow) and the desirable septal length to support the nasal tip (green line). The operative frontal view is off centre but still shows the deviated nasal septum (green line) and asymmetry of size, shape and rotation of the tip cartilages (yellow outlines). The nasal foundations were addressed with a septal extension and spreader grafts to straighten a deviated septum and provide adequate tip support. The bridge was smoothed, nasal bones brought in and bulky scar tissue removed from the tip. The tip was secured into position and refined with fine cartilage grafts.