Fig. 6.

Class 4 level complexity of revision. This patient presented with a saddle nose deformity, inverted-V deformity, open roof deformity, tip overprojection, and bilateral internal and external nasal valve collapse. Her revision included the use of five cartilage grafts using cadaveric costal cartilage (bilateral spreader grafts, bilateral alar batten grafts, columellar strut graft, and dorsal augmentation graft), one soft-tissue graft using ADM, and advanced tip reconstruction via vertical lobular division. (The images are provided courtesy of Fred J. Bressler, MD.)