Table 4.

Anatomic Findings and Techniques in Revisional Rhinoplasty

Findings	Technique Used
Low bony dorsum	Costal cartilage graft with muscle fascia
Irregular or wide bony dorsum	Osteoplasty and/or ultrasonic osteotomy
Cartilaginous dorsum with hump or supratip	Reduction of cartilaginous septum and/or spreader flaps
Low cartilaginous dorsum	Rib graft and/or reconstruction of keystone area with transosseous points in the nasal bone
S-shaped cartilaginous dorsum	Spreader graft or replacement with L-shaped rib graft
Absence of dorsal aesthetic lines	Paramedian, lateral and transverse osteotomy plus spreader graft
Deviated caudal septum	Reposition with transosseous stitches in the anterior nasal spine or replacement with costal cartilage
Septal spur or residual septal deviation	Secondary septoplasty
Turbinate hypertrophy	Dislocation and infiltration with corticosteroid
Internal synechiae	Release of synechiae and nasal splints for 7 d
Drooping nose tip	Bilateral septal extension graft (SEG)
Thick skin	SMAS and Pitanguy ligament removal and suture placement between supratip and SEG (Guyuron stitch)
Alar collapse	Alar rim graft and lateral crura tension steal with neodome positioning
Alar retraction	Auricular composite graft
External nasal valve dysfunction	Resting angle correction with a figure-8 suture between “W” septal point and lateral cruras.