Dr. Nassif: Following the osteotomies the goal at this point was to make the middle part of the nose more symmetric; the right side was caved in a little bit. So we can see that the ride side of the nose is narrow. Right here we’re going to put a spreader graft which will spread this area and also the bone in this area is pushed in a little bit. So we’re going to build this out and build that out to try to match this side.
We’re making a space for the spreader graft to go in between the septum which is on this part and the upper lateral cartilage which is right here on the right. So we’re going to go carve another piece of cartilage for this. So we’re just about to carve the spreader graft, I want to make this kind of thin. So this will be it right about here. We can also use these as rim grafts too which we’ll be doing that later on.
What a spreader graft is used for is to one open up the internal nasal valve to make you breathe easier. So we’re making the little pocket. It’s usually something that’s length wise with the nose and we can carve it to different widths and different lengths. But the whole goal with a spreader graft is to widen the nose and open up your airway more; it’s a wonderful tool.
So we’re going to put this spreader graft inside here like we’re doing and stitch it in. So that spreader graft has already made this side come out a little bit more, it’s more symmetric. We’re not finished yet completely but that was our goal to make this area wider, so it’s doing its job. It’s more symmetric in the middle part of the nose but not completely symmetric in the upper part of the nose but we’re still working on that. Now we’re closing the rest of the area that we’ve opened up and this is the upper lateral cartilages and we’re just putting this back together.
So my preoperative analysis I thought that she might need this right spreader graft and obviously I confirm this while on the operating room table. After I was finished doing that I still wasn’t 100% pleased with the symmetry of the right middle part of the nose. So I still see a little bit of narrowing right through here on top of this bone. Maybe if we put a little layer of fascia that might help. That’s our goal with the perichondrium to put it right there. Now let’s just see how that looks once I get it inside.So we took pieces of that perichondrium from the rib and laid it right on top of that area that was a little deficient and that really took care of the problem.
Today it’s her three month post-op. She looks great, she’s still healing and she’s still swollen. She can breathe a lot better than before surgery; she’s exactly where she should be. And right now the way it looks I think this hopefully will be her last surgery. I’m extremely happy with where she’s at right now I love her nose and it’s only going to get better.’