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The secondary rhinoplasty is always difficult to plan and execute. This patient's original operation left him with a thin dorsum, poor support of the mid-section (essential for proper air-flow), a displaced tip cartilage graft and an interrupted columella line (follow the nose from the lip junction to the tip of the nose on the pre-operative profile). Corrective rebuilding surgery (utilizing ear and septal cartilages) re-established balance and air flow.
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