• an open rhinoplasty approach gives superior access and visualization for complex septal, middle vault, and nasal tip reconstruction

  • after closing the external nose/columellar incision, small telfa packing coated with ointment is put inside of each nostril, and tied together in the front with black strings (the day after surgery, this packing is removed at home by the patient--it should just "slip out" and is not painful)

  • Before surgery - external nasal valve collapse, worse with inspiration

  • intra-op photo showing external nasal valve reconstruction maneuver (caudal repositioning of the lower lateral crura with underlay lateral crural strut grafts made from autologous septal cartilage

  • After surgery (nasal valve reconstruction via open rhinoplasty approach) - no nasal valve collapse

  • Before surgery

  • After surgery

  • Intra-op view of rib grafting at nasal tip

  • Before (revision rhinoplasty) surgery

  • After surgery (revision open septorhinoplasty with autologous rib cartilage grafting - to improve nasal breathing and nasal tip symmetry)

  • Before

  • After

  • Before

  • After

  • Before

  • After

  • Before

  • After

  • Before

  • After

  • reconstructive septorhinoplasty for congenital (cleft) nasal deformity - intraop view of autologous nasal septal cartilage used as grafting material for external nasal valve reconstruction

  • before closing

  • after incision closure, before nasal dressings placed

  • mid columellar and alar base incisions (sutures that will be removed 1 week after surgery)

  • end op photo after open septorhinoplasty (and alar base reduction) - the patient removes the internal nasal packing (with the black strings) the day after surgery, and the external tape and cast and sutures are removed in Dr. Brennan's office a week after surgery