Structural rhinoplasty in thin skin with S-shaped hump: result after one year
Case fact sheet
- Patient: 30 year old woman
- Starting nose: thin skin, S-shaped back with a very prominent ridge and caudal deviation of the septum to the left, which displaced the foot from the left medial crus and covered that nostril; piercing in the fin
- Technique: structural rhinoplasty with ultrasonic instrumentation, spacer grafts (spreader grafts), septal extensor and reduction of the base of the wings (allotomy)
- Partition: Caudal deviation corrected in the same surgery
- Approach: Remove the saddle and leave the back straight and smooth in a thin skin, center the caudal septum, give the tip a stable support and narrow the base of the wings
- Result: one year after the operation
- Entry: 1 night
- Anesthesia: General type TIVA
- Duration: 3 hours long.
Thin-skinned nose with an S-shaped dorsum, a very prominent bridge, and a septum deviated to the left in its caudal portion, obstructing the left nostril. Structural rhinoplasty with ultrasonic instrumentation, spacer grafts, septal extender, and alar base reduction. Photos of the result one year later.
Photos one year after the operation
Twelve-month check-up. In this case, the year is important for two reasons: the bridge, with its thin skin, can only be properly assessed once the swelling has completely subsided, and the base, where the septum was repositioned and the nostrils narrowed, needs months to settle; the view from below reveals this. A photo taken immediately after surgery or in the first few weeks, however striking it may be on social media, doesn't tell you how the nose will ultimately look. The before and after a year, with the same views, the same lighting, and the same framing, are crucial.
Comment by Dr. Gustavo Sordo
Reason for consultation
He was bothered by the easel that was visible in profile and he was breathing poorly through his left side.
What I observed when evaluating it
It had thin skin and an S-shaped back with a very prominent ridge. In the basal view, the caudal part of the septum was deviated to the left and pushed the foot of the left medial crus, which covered part of that nostril. It also had a piercing in its fin.
What was important to preserve
A smooth back: with such thin skin, any bony prominence would have been noticeable. And the piercing area, because sometimes the pierced tract retracts after surgery, leaving a sunken scar.
My surgical approach
Lower the bridge and leave the back straight, bring the caudal septum to the midline to clear the left nostril, give the tip a stable support, narrow the base of the wings and release the tissue around the piercing.
Why I chose this technique
In thin skin, the bone must be smoothed. With ultrasonic rhinoplasty, the dorsal hump is reduced by filing the bone in a controlled manner, resulting in a regular dorsum. Spacer grafts reconstruct the mid-dorsum after removing a large hump and help maintain airflow; the septal extender holds the caudal septum in place and provides firm support to the tip. In the alar resection, some surgeons prefer to make the incision one or two millimeters above the crease where the alar wing meets the face; I make it right in that crease because I believe the scar is less visible.
What I did during surgery
I reduced the bridge of the piercing with ultrasonic instruments, straightened the caudal portion of the septum and brought it to the midline, placed spacer grafts on both sides of the septum, and a septal extension graft to secure the tip. I reduced the base of the wings with an allotomy, making the incision right at the line where the wing meets the face. I also released the retracted tissue around the piercing, which complicates the surgery somewhat. The operation lasted three hours, under TIVA general anesthesia, and the patient stayed overnight in the hospital.
What is observed in the result
At one year old, the profile is straight, without the S-shaped curve on the back or the ridge. In the basal view, the columella is centered, and both nostrils are open and more symmetrical. The base of the wings is narrower, and the allotomy scar is located in the wing fold. There is no depression in the piercing area.
More cases and an explanation of the technique can be found on the rhinoplasty page in Madrid.
Case operated on by Dr. Gustavo Sordo
Specialist in Plastic, Aesthetic and Reconstructive Surgery. Member No. 282858125.
Before you compare yourself to this photo
The ultrasonic scalpel allows for more precise bone work and typically leaves less bruising. It truly makes a difference in ultrasonic rhinoplasty.
Do you want to know if this can be done in your case?
The first consultation is with Dr. Sordo, either at the Chamberí clinic or via video consultation. You'll leave knowing if you're a candidate, which technique is right for you, and how much it costs.
Dr. Gustavo Sordo · Member No. 282858125 · Plastic, Aesthetic and Reconstructive Surgery · Madrid