Hi there, Dr. James Southwell-Keely here, and welcome to my case studies. Procedure is rhinoplasty. This patient came to me having fractured his nose. As a result of the fracturing of his nose, his nose had been flattened down towards the plane of his face, causing an apparent widening of the nose and a dropping in the tip of the nose, a lowering of the tip of the nose. He’s otherwise fit and well, so after a detailed workup, we proceeded to the operating theater.

This type of rhinoplasty is called an augmentation rhinoplasty. I need to add additional structural, to augment the dorsum of the nose, or the top of the nose, in order to restore its previous shape and balance. This fellow, I’ve taken some cartilage from his ear. The scar for the ear cartilage harvest is hidden behind the ear, so it is not apparent to the observer. In order to access the nose for its rebuilding, a small incision is made in the columella, which is the strip of skin between the right and the left nostrils. The skin of the nose is then elevated, exposing the underlying bone and cartilage. I used the ear cartilage that I took earlier in the procedure to mince up and create what’s called Turkish delight. It’s wrapped in a layer of special material, and then inserted beneath the skin of the nose, in order to restore its shape and balance.

With additional cartilage grafting into the tip, and into the columella itself, projection can be restored to the nose. Nearby, a vastly improved nasal shape and better balance, not only to his nose, but to his whole face. The incision in the columella is closed with sutures that are removed at the first postoperative week. And he wears the split for two weeks. I see all my patients at that first and the second week mark. And then again at six weeks and six months. I was happy for this patient to resume normal exercise at the six week mark. And the images that I’m showing you today are taken at roughly the eight months post-op [inaudible]. His final nasal shape will declare itself over the ensuing months, probably from the 12 month mark onwards, it will be fairly stable. If you have any questions regarding rhinoplasty, please don’t hesitate to reach out to me.