02/20/2026
This patient presented at 42 years of age after undergoing four prior rhinoplasties. In one of the latest surgeries, MedPor spreader grafts were placed. She complained of severe nasal obstruction and deformity. The patient had collapse of her internal and external nasal valves. Her reconstruction required harvesting a segment of her seventh rib and reconstructing using a caudal septal replacement graft, spreader grafts, and lateral crural strut grafts. The MedPor implants were removed at the time of her surgery.
She is 17 years postoperative and doing well, with excellent nasal function and much-improved aesthetics.
The patient has minor asymmetries in the appearance of her nasal base on postoperative views. It is important for patients to understand that perfection in rhinoplasty is not possible. In fact, almost all patients have minor asymmetries and defects. When assessing a case, it is important to consider the patient’s preoperative nasal condition, the complexity of the operation, and the length of follow-up.
I find it interesting when I post a patient’s long-term outcome, and some will make remarks about the imperfections. Please consider the difficulty of the secondary rhinoplasty operation and the challenge of providing a result that lasts a patient’s lifetime. This patient is 17 years postoperative and will likely do well for the remainder of her life. This is a very important consideration when assessing the outcome after rhinoplasty. Imperfections are part of the process. You should also consider that the patents themselves may have different aesthetic requests that may not align with yours. This is the patient’s prerogative. I sometimes see commentary that someone likes the pre-op state better. This is likely not the case for the patient. Everyone’s aesthetics are different and must be considered when assessing long-term outcomes.
