The “biggest bang for your buck” will come from supporting the area between the external and internal nasal valves, the inter-valve area. This spot corresponds to the supra-alar crease externally and the lateral aspect of the lateral crus structurally. A deep supra-alar crease is often a sign that the inter-valve area is a contributor to the obstruction. “You just lift that spot just a touch, a couple millimeters, and the patient will say, ‘That’s it, whatever you did, Doc, that’s exactly what I need you to do,’” Dr. Park said.
Explore This IssueFebruary 2014
When he does a revision functional rhinoplasty, the initial operative note usually sounds perfect, but when he goes in, the most common mistake is usually that the batten graft has been placed in the wrong spot; frequently it is incorrectly sitting on top of the lateral crus and occasionally on the nasal bone. “Precise placement of this batten graft, I believe, is key,” he said. “It’s non-anatomic, it’s not on top of cartilage, but within the soft tissue area of the lateral nasal wall. It is then suture secured.”