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Reconstructive rhinoplasty refers to restoring the normal shape and function of the nose following damage from a traumatic accident, autoimmune disorder, intra-nasal drug abuse, previous injudicious cosmetic surgery, cancer involvement, or congenital abnormality. Rhinoplasty can restore skin coverage, recreate normal contours, and re-establish nasal airflow. To improve nasal breathing function, a septoplasty may also be performed.

Rhinoplasty may be sought in the aftermath of traumatic deformity. Traumatic accidents are the most common cause of nasal deformity. Typically, the nasal bones are broken and displaced. Occasionally, the nasal cartilages are disrupted or displaced, and in the worst cases, the nasal dorsum is collapsed. Rhinoplasty allows shaving of the displaced bony humps, and re-alignment of the nasal bones after they are cut. When cartilage is disrupted, stitching of the cartilage for re-suspension, or use of cartilage grafts to camouflage depressions allows re-establishment of normal nasal contour. When the dorsum is collapsed, grafts of rib cartilage, ear cartilage, or cranial bone can be used to restore continuity to the dorsum. Although synthetic implants are also available for augmenting the nasal dorsum, cartilage or bone graft from the patient’s own body poses fewer risks of infection or rejection.

Rhinoplasty to correct nasal obstruction following injudicious cosmetic surgery is common. After a normal period of wait from 6 to 9 months, the patient notices that the airflow still is difficult in one or both sides. Reconstructive rhinoplasty after aggressive cosmetic surgery allows the restoration of normal breathing. When nasal cartilages are over-aggressively trimmed during rhinoplasty, the nose can appear pinched and nasal patency compromised. Patients complain of nasal blockage that is worsened by attempts at deep inspiration. Internal cartilage grafts to support the nasal tip (batton grafts) or widen the middle vault of the nose (spreader grafts) can be quite effective in restoring normal breathing. These grafting techniques will increase the size of the nasal tip and widen the dorsum.

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