For the patient with overreduced nasal bones, the nose may be balanced by placing a graft placed in the region of the radix properly reducing the cartilaginous septum. For the underresected cartilaginous dorsum, resection is recommended with careful intraoperative assessment of the relationship to the tip. Tissue edema should be minimal to accurately judge this relationship. For the external rhinoplasty approach, redrape the skin-soft tissue envelope prior to evaluation of the profile. Analysis of photographs prior to surgery involves evaluating especially the lateral view of the patient who has a polly beak deformity.
Physical examination complements the photographic analysis, enabling accurate surgical planning.
Remove the cast in one week. Make preliminary assessment of the outcome after cast removal. If there is significant edema, patient should be retaped and return in 1-2 weeks. If it is determined that a patient has excessive supratip edema, steroid injection may be performed 4-6 weeks postoperatively. Generally, full-thickness skin loss occurs with operating in the improper plane and overly aggressive resection, which transgresses the dermis.