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Author: admin | 29.03.2015 | Category: Relieve Tinnitus

What is most important to establish in revision rhinoplasty during the consultation process? It is most important to determine from the patient what were they trying to accomplish with the first surgery and what are their goals with the revision rhinoplasty.
Typically, it is necessary to wait 1 year for the swelling to resolve prior to doing a revision or secondary rhinoplasty.
Dr Sam Rizk, does an extensive internal and external examination for a patient requesting revision rhinoplasty. Typically, it takes 2.5-3 hours but it may take longer depending on degree of defromity and the amount of work needed to obtain donor tissue. Dr Sam Rizk provides his patient with a nasal kit containing medicines which expedite the healing process. It takes normally 1 week to look presentable and most patients return to work or their regular daily activity at 1 week. If I have collapse in different areas of my nose causing either a scoop or saddle or a pinched tip deformity or a drooping nasal tip where will surgeon obtain grafts or implants to correct deformity? Very often in revision rhinoplasty after a previously overaggressive rhinoplasty, it is necessary to use pieces of cartilage to support or augment areas of collapse. If too much was removed from the bottom part of the nasal septum, the columella (middle piece of skin separating the right and left nostrils) becomes pulled up too much or retracted, the upper lip can then appear flatter and longer. There are many reasons why a nose may become crooked after a rhinoplasty and each require a separate treatment, according to Dr Sam Rizk. Dr Rizk has 2 innovations that allow for a more precise result and smoother more natural result in revision rhinoplasty. Second, as most revision rhinoplasty surgeries resulting from overresection of tissue causing a crooked nose or pinched nasal tip will require cartilage grafts, Dr Rizk has developed a method of better sculpting cartilage grafts or nasal implants to create smooth edges, which are not palpated as a sharp edge. If my nostrils have been pulled up from a previous rhinoplasty, so-called alar retraction, how does Dr Rizk correct this deformity? Alar retraction, which makes the nostrils appear pulled up usually results from a rhinoplasty where too much cartilage and mucosa was removed during the previous surgery. 25 year old female revision rhinoplasty patient had severe deformity from previous rhinoplasty surgeon. 35 year old female Latina Revision rhinoplasty patient removed her bumps and straightened her nose.
25 year old female had rhinoplasty 8 years ago and came to our New York rhinoplasty surgeon Dr. 35 year old doctor had severe difficulty breathing so she underwent revision rhinoplasty with Dr.
The term Cartilage Piercing, is made of tough elastic tissues located particularly in nose, neck, forehead as well as on the ear specifically just below on the rook of the ear that is highly susceptible to infections and bumps. In addition, studies showed for about sixty-two (62) percent of individuals worldwide have done this procedure to express their personality as well as their individuality. Systematically, cartilage piercing infection is caused primarily by pathogen named Staphylococcus Aureus and Pseudomnas Aeruginosa if not treated may lead to a permanent ear deformation and swelling.
Over cleaning : the affected area will become weak and great possibility of infection may exist. A procedure often appears to be gradually more rampant among adolescents and young adults if not quickly treated. Overcleaning – The affected area may loss enough ability to fight and allows the infection to takes place. Studies showed that infections generally manifest within two (2) to five (5) weeks of piercing.
Piercing infection can appear or can take as mush as three (3) to twelve (12) months to completely heal the problem based on the type of procedure you undergo.
Applied directly using cotton balls for about five (5) to ten (10) minutes and then rinse it thoroughly once or thrice a week. Place the chamomile tea in a container filled with hot water and holds it for about a minute then place it to the affected area. Keloids – It shows due to excessive tissue repair and it can be treated only through surgery. The healing time of cartilage pierce typically varies extensively according to the situation and severity of the condition.
Growth or proliferative stage, wherein the body produces cells and protein to our body in order to heal the puncture and the edges contract around the piercing. Mine isn’t red,swollen or sore it just has a bump at the back it feels like my bone that was pierced through???? Every person has their own pain tolerance so it would be harder to specify, however, in general, cartilage piercings are not that painful. One thing to remember is that even if your piercing already looks perfect after two months, it is still not healed. In the first three days, sanitize the pierced area twice a day, in the morning and at night.
When done bathing, never forget to rinse the ear with running water to remove soap, conditioner or any cleaning product residue. In the next four weeks, you can clean the piercing once a day following the first three steps. We generally recommend these two products that will have you covered in 99.99% of the cases if you follow the instructions properly. This Piercing Aftercare Spray is enriched with over 60 trace elements and minerals from the richest coral reefs of the ocean along with natural antibacterial enzymes which kill bacteria & help protect healthy living cells.
H2Ocean increases circulation to the body or mouth piercing and accelerates the healing process. Conquering your fear with the piercing process myths can only be done if you are aware of the real expectations. Piercing Models is a site for all your piercings and tattoo queries, inspiration, artistic ideas, designs and professional information. Tags with a substantial cartilage core are best treated by excision of the skin tag and cartilage spindle under general anaesthetic.
THE FOLLOWING ARE THE MOST COMMON ISSUES BROUGHT UP BY REVISION RHINOPLASTY PATIENTS TO DR. First, it is important to realize that revision rhinoplasty is a small specialty with very few surgeons who specialize in it.
If the tip of your nose looks pointy, this is probably related to removing too much cartilage in previous surgeries and over time the tip can become weak and start to twist.
It is a normal emotion to be afraid of a revision rhinoplasty, especially since a patient has already had an unpleasant experience.
There are 2 approaches to revision procedure, so called endonasal (closed) or open rhinoplasty (external). The term “revision rhinoplasty” refers to secondary surgery, often performed on unsatisfied patients who do not like the results of their primary surgery.
Patients have sometimes had up to 6 or 7 previous rhinoplasties and were unhappy with the results.
Sometimes revisions are necessary even if surgery was performed by adequately trained surgeons and patient had poor healing. Patients who underwent primary nose surgery years ago exhibit defects in the structural support of the nose. Besides the higher technical challenge, there are also additional complications such as the need to improve an airway blockage by correcting a deviated septum and reducing an enlarged turbinate.
The key to formulating a treatment plan in revision rhinoplasty is a THOROUGH NASAL EXAM AND DIAGNOSES.
Repairing the internal and external nasal structures is done together and the goal is not just an aesthetically pleasing natural outcome but also a functioning nose where the patient is able to breathe.
After a rhinoplasty procedure with a different surgeon, our 55 years old male patient underwent a revision rhinoplasty with Dr. An interior designer in her mid fifties is shown here two years after a revision rhinoplasty to repair the tip of her nose which had begun to droop. 55 year old female with previous rhinoplasty complains of overrotated nose, pointy tip, saddle nose and inability to breathe. A 53 year old female required revision open rhinoplasty to rectify a saddle nose with a twisted bulbous tip.
A 26 year old female is shown here after having had rhinoplasty in the past, but her tip began to droop and the right side of her nose collapsed. 45 year old male who underwent revision rhinoplasty to fix his asymmetric pinched tip as well as saddle nose deformity. 27 year old Asian female who had a previous rhinoplasty with silicone implant which became infected and extruded through her tip and also became crooked. 48 year old female with previous history of rhinoplasty unhappy with her front view irregularities and areas of collapse (worse on right side) and inability to breathe. 31 yo old male Indian doctor who underwent previous rhinoplasty in Beverly Hills who is dissatisfied with his lack of definition and his scooped feminized nose. 25 year old female who underwent rhinoplasty 8 years ago and was very dissatisfied with her nose. 25yo female with a severe rhinoplasty deformity from a previous rhinoplasty with both a floating bone open roof problem as well as tip bulbosity. Add important lessons to your Custom Course, track your progress, and achieve your study goals faster. A hematoma forms when blood pools outside of a blood vessel, and they can form anywhere in the body.
Symptoms of a HematomaSymptoms vary based on where the hematoma is located, how big it is, and its proximity to other structures. Be sure your surgeon has a history of success with revision rhinoplasty and ask to see pictures during your consultation. Be sure your surgeon is a nose specialist or facial plastic surgeon who specializes in the nose and not a general plastic surgeon. Be sure your surgeon is board certified by the American Board of facial plastic and reconstructive surgery.
Ask the facial plastic surgeon if he has some patients that you could speak with before your surgery.


Drooping of the nasal tip secondary to not supporting it in the first operation with cartilage grafts if the tip had weak support to begin with. Hanging columella (the middle center piece of skin in the nose separating the right and left nostrils). There are rare exceptions to the rule if there is an obvious deformity which may need to be repaired sooner. It should not take longer than 4 hours since the swelling in the nose will distort it to the point where the surgeon cannot judge subtle finesse aspects of the rhinoplasty adequately. It takes 1 month to return to exercising, and 1 year on average to attain the final result. Dr Rizk states that he first looks for donor sites in the nasal septum followed by the patient's ear followed by rib cartilage from a rib bank.
To correct this, an implant or nasal graft called a plumping graft or subnasal graft may be used to push the columella down and lift the upper lip region.
A procedure which used to creates opening in the ear to insert jewelries such as rings, etc. Others used this as a sign of being cool and sexy without proper knowledge and information of the procedures that are being used that may lead to some severe infections if not treated immediately. Precise concern should be specified to minimize and avoid serious ear problems which can contribute to the deformation of the affected area of the ear. This was 4 days ago, hers doesn’t hurt any more at all and mine hurts so bad I literally lay in the floor and cry. Getting your ear pierced is an easy process but there are many things to consider before getting one. Piercing’s Aftercare swabs are developed exclusively for the care and cleaning of piercings and help prevent infection.
Natural Healing & Cleansing Solution H2Ocean safely removes dried discharge and lymph secretion when used every 2-3 hours.
Whether it is your first time getting a piercing or if you are are professional in the industry, this website will help you select the best piercing or tattoo for you and provide you with the information you need to take good care of your piercings and tattoos.
Sometimes the tags are of skin only, but usually the tag contains a long tail of cartilage extending into the cheek.
Clefts of the ear and ear lobe occur when two or more of the hillocks which form the ear during development fail to join together normally.
The surgeon should do at least a minimum of 4 revision rhinoplasty surgeries per week and should have a lot of pictures showing revision rhinoplasty patients. Rizk will not be able to perform a revision rhinoplasty if he feels the nose is beyond repair. Rizk determines you are a good candidate for cosmetic surgery, he will formulate a plan which will include whether he will use open or closed approaches, whether he will use cartilage for grafts or implants, and if cartilage will be used he will also discuss possible sources such as septum, ear, or banked rib cartilage.
Computer imaging may give you an idea from profile in some noses but is somewhat inaccurate in nose surgery, especially from the front view. Sometimes too much cartilage was removed and the skin does not have enough support and may collapse, sometimes the patient's own cartilages are too weak and after a reduction procedure became weaker, sometimes the skin is too thick and collapses with inspiration, and sometimes an underlying deviated septum becomes more symptomatic after the nose is made smaller in a rhinoplasty. If you do not like the way your nose looks or cannot breathe well and you are in good health, you might be a good candidate. However, it is very inaccurate from the front view and should not be relied upon because it can be misleading. The endonasal technique is done with small incisions inside the nose and the external or open rhinoplasty is done with a small incision in the middle of the columella (center bottom part of the nose). Rizk has a large number of patients in his practice that travel to his Park Avenue Center to undergo revision rhinoplasty from different states or countries. But a surgeon needs to understand the internal support mechanisms of the nose and be trained with a background in ENT and facial plastic surgery to not violate these support structures of the nose.
Rizk likes to review old operative reports from previous rhinoplasty surgery, pictures of the patient's old nose prior to any alteration, and pictures of the nose after each of the previous rhinoplasty surgeries, if possible. She also had a necklift and a lower blepharoplasty with laser skin resurfacing which tightened her skin. Patient shown 5 years after Revision Rhinoplasty with multiple cartilage grafts from ears and septum to build her tip, elongate her nose and rotate it down. As you can see, a considerable amount of bone was removed from her nose above its tip but not enough cartilage. The surgeon removed a good amount of cartilage from her nose which resulted in a very pinched nasal tip as well as a scooped out area close to the left nostril. Cartilage was grafted from her septum and ear to straighten and restore the shape of her nose.
Revision rhinoplasty was performed by adding cartilage to the right side of her nose to repair the collapse and additional cartilage was used to support her tip and prevent it from drooping. She also has a mild saddle nose on profile and on frontal view, external nasal valve collapse was worse on the right. Patient had multiple collapsed areas in his nose corrected with cartilage grafts from his septum.
Patient shown after revision rhinoplasty using septal and auricular cartilage grafts to correct multiple areas of deformities and collapses. Patient is shown only 1 week after revision rhinoplasty with multiple sculpted grafts in his tip and bridge to masculinize his nose and successfully define it despite having very thick skin with underlying scar tissue.
Her preoperative pictures shows the typical stigma associated with an overreduced rhinoplasty.
Read this lesson to learn what causes a hematoma, the different types, possible symptoms, and treatment options. A hematoma is a collection of blood that has started to clot outside of the blood vessels, and they can form anywhere in the body, including in organs. The advantage the revision rhinoplasty surgeon has that the first surgeon did not is the knowledge of how the nose responded to surgery. Rizk also inserts a high definition telescope during his examination into the nose to assess the support structures, the septum, the turbinates and areas of inspiratory collapse.
Also the longer it takes, the more the skin stretches and some swelling may last for a very long time where it becomes replaced with scar tissue. Dr Rizk points out that the nose continues to change even after 1 year and more refinement occurs, especially after revision rhinoplasty where swelling may persist longer than 1 year. Our patient is shown after endonasal 3D rhinoplasty using cartilage from the ear to fix collapsed areas.
Knowing more about cartilage piercing is necessary to ensure you know what to expect before, during and after the procedure. Things to consider are the reputation of the shop, the experience of the piercer and the type of earring you will use. The sensation felt while the needle is inserted to the cartilage is comparable to a dull pinch. These swabs are conveniently packaged using advanced technology for easy, sanitary application. This is quick and easy to do, requiring no anaesthetic, and a few days later the tag drops off.
He must specialize in facial plastic surgery and be board-certified by the American Board Of Facial Plastic and Reconstructive Surgery.
It is important for patients to understand that revision rhinoplasty requires specialized training and expertise and finding a skilled surgeon who specializes in nose surgery is necessary to maximize your chances for a favorable outcome. Whatever the cause is, this is a very fixable problem and may require adding more cartilage to the nose or repairing the nasal septum. In revision rhinoplasty, there are many surgical factors which determine the final shape of the nose which cannot be shown by Dr. Rizk's confidence and experience in his results with surgical procedure makes the patient immediately feel at ease.
Sam Rizk has specific techniques he developed and has extensive experience with these noses. Patients stay in various hotels and need to remain in New York City for 1 week after the surgery.
Samieh Rizk, a New York double board certified facial plastic surgeon with extensive experience and skills in both rhinoplasty and revision surgery, performs these procedures on a daily basis.
Rizk operates only if the patient is realistic about their expectations and if they are in good physical and mental health and are unhappy about either their cosmetic appearance or their breathing. Rizk always performs a detailed examination of the internal and external nasal structures and any abnormalities evident on both static and dynamic examinations (ie.
I also improved her breathing by correcting external nasal valve collapse, where the skin of the nose collapses on inspiration due to excessive removal of cartilage. The results shown here are after only two months and they will continue to heal for up to a year.
Patient is shown after endonasal 3D rhinoplasty with ear cartilage grafts to correct the collapsed areas.
Preoperative pictures shows the following deformities from the profile: Scooped out saddled cartilage bridge and a bony bump, overprojected tip with a hanging columella, pointy tip on the right.
This was corrected with cartilage grafts obtained from patient's septum and suture techniques were used to make tip cartilages narrower.
This is very important also to assess the existence of donor cartilage, which is typically needed in revision rhinoplasty.
I don’t know if I should take out the earring or leave it and just do salt water soaks and clean it. Then, the piercer will mark the area in your ear cartilage and will let you see the dot mark in the mirror. RIZK DOES NOT PERFORM BODY PLASTIC SURGERY AND HIS PRACTICE FOCUSES ON THE NOSE AND FACE ONLY.
It usually results from over-resection of cartilage or overreduction of the bony part of the nose, often resulting in a scooped, upturned, or pointy nose.
His staff will help you through the process and will be a large part of your more pleasant experience both before and after your surgery. He sees a large number of these noses in revision rhinoplasty with loss of tip support and postoperative tip drop which he corrects. Rizk performs revision procedure with both the endonasal endoscopic technique as well as the open technique, depending on the nose and what is needed.


Rizk also provides patients with a rapid recovery packet of medicines which he feels promote a quicker recovery. He explains that revision surgical procedure surgery is a more challenging procedure than a rhinoplasty since the nasal structure may have lost some of its original anatomical characteristics and patients tend to have scar tissue which makes it more difficult to improve both functional and cosmetic results. Rizk does have areas of collapses from over-aggressive resections of cartilage done previously with scooped ski-slope noses and pointy or upturned tips. Medpor is an artificial implant that has holes in it and integrates into the nose with ingrowth of tissue to stabilize it and is sometimes used by Dr.
Many patients had a previous nose job done using silicone implants which were not integrated with their bodies, changing their location within the nose months after surgery. Operating on a 3D structure in the middle of one's face such as the nose is much more accurate when using 3D technology to better visualize the intranasal structures. Thus, a revision rhinoplasty was performed by having an ear cartilage graft to correct the area where too much bone was removed, the excess cartilage above the nose’s tip was reduced, and the nose itself lengthened with a caudal septal graft of cartilage. So, revision rhinoplasty was done requiring cartilage grafts from her septum to repair the damages.
Preoperative picture from the front view shows the following deformities: open roof deformity near the bony top part of nose, inverted v deformity in the cartilage part of nose, pointy tip on right, and hanging columella. Hematoma CausesSimply put, a hematoma is caused by some type of damage to a blood vessel that causes blood to leak out into places it has no business being.
Very often, the septum (parting wall between right and left sides of nose) may be missing and may not be a good source of cartilage.
Sam Rizk, therefore, does not feel it is necessary or prudent for a very prolonged operation such as 6-7 hours. After that is the actual piercing where the piercer will clamp your ear in place and use a hollow needle to create the hole in your ear.
This completes the pack in 4 weeks and after this point, good routine hygiene with liquid soap (anti-bacterial if preferred) and water should continue the healing process.
It is absolutely vital when taking care of a piercing to make sure that bacteria isn’t introduced to the affected area, and the only way to do this is by using a sterile formula like this one.
These patients have thick skin which gets even thicker with scar tissue from previous rhinoplasty. If an open is performed, the incision on the columella heals excellent and is almost invisible. Many of these patients can't breathe because of these multiple areas of collapses and require a highly trained facial plastic surgeon that does many revisions.
The body naturally creates a space between the nose's tissue and the alien silicone object. This can detect areas of nasal collapse, inverted v-deformities, external and internal nasal valve collapse, pinched tips, saddle nose deformities, scar tissue, pollybeak deformities, thick skin, weak tip support, drooping nasal tips, as well as functional conditions such as a deviated nasal septum, twisted nose, turbinate enlargement and sinus disease. Lastly, the right nostril was reduced in size to make her overall look appear proportionate.
The cartilage used on the left alar rim fixed the scooped out hole, the lower bilateral grafts were used for the pinched tip, and the caudal septal extension graft corrected the length of her nose.
Therefore, the revision rhinoplasty surgeon will have to look for other sources of donor sites for cartilage like the ear or external implants. Next, the piercer will insert the needle halfway to your ear and thread the jewelry in place. In the case of an oral piercing we also recommend getting the aftercare mouthwash to protect your new piercing. A patient must evaluate the surgeon's experience by speaking to them and seeing their pictures. Rizk has extensive experience with revision nose surgery and can rebuild lost or collapsed areas with grafting techniques. Rizk will only choose to operate if he sees obvious deformed areas or if the patient cannot breathe. Please see the photo album below which will show patients with this problem who were successfully treated. Rizk will talk to you and examine your nose in detail, both the external nose and the inside of the nose to determine if you are a good candidate and if your goals and expectations are reasonable and can be met. Rizk will answer any of your questions and may put you in touch with some of his patients who have had a revision rhinoplasty to ease your fears.
Patients usually return to work 1 week following their revision surgery, but swelling continues to diminish for up to a year after the surgery.
Rizk sees many patients who have revision noses with multiple areas of collapse and pointy edges, he has innovated new technology and tools to micro-sculpt sharp edged cartilages which far surpasses older technology using a regular knife to reshape cartilages. Additionally, patient could not breathe preoperatively secondary to a deviated septum and could breathe after that was fixed at the same time.
Trauma is the most common cause of a hematoma, but this doesn't include just major traumas like car accidents or falling off a building.
C is for compression - applying pressure can help stop further bleeding and encourage circulation. The external examination should focus on areas of irregularities, skin thickness, asymmetries, areas of collapse or cartilage deficit, the support of the tip, tip droopiness, recurrence of a nasal bump, degree of tip definition, a hanging columella, adequate narrowing in the bony region of the nose, and finally the nostrils and asymmetries of the nostrils. There are cases where the piercing makes a bit of bleeding but most of the time, it does not. A surgeon who is a general plastic surgeon who also does body and breast surgery probably does not specialize enough in revision surgical procedure. Rizk's sculpting methods for cartilage grafts is a major breakthrough in revision rhinoplasty to avoid the pointy, unnatural tip. Rizk has specialized defatting techniques to remove scar tissue and cartilage sculpting techniques which form smooth grafts without sharp, pointy edges. Rizk's experience the endonasal technique is more suitable for lateral (on the side of the nose) collapses and the open technique is more suitable for central collapses in the tip. Aspirin and products that cause bleeding such as vitamin E, ginko biloba, or fish oil should be discontinued 2 weeks before surgery and 2 weeks after the revision rhinoplasty.
Rizk will choose the open rhinoplasty technique and sometimes he will choose the closed (endonasal rhinoplasty) technique depending on the deformity. Rizk is one of only a few double board facial plastic surgeons worldwide who has a large practice and experience with revision rhinoplasty. Trauma can be as simple as a sneeze or cough that is strong enough to damage a blood vessel.
E is for elevate - holding the area above the level of the heart (if possible) can also help reduce swelling.
For you to have an idea for your jewelry, below are cartilage piercing inspirations and jewelry. Additionally, very often, patients have a functional breathing problem after their initial rhinoplasties and the best surgeon to handle these issues is one who is double board certified in Otolaryngology (ENT) and Facial Plastic Surgery. Rizk may choose not to operate even though there are deformities and even though the patient is in good health.
Please see various sections on this website on these specific ethnicities for more information. Many times cartilage grafts need to be added to correct various areas of collapses or to smoothe sharp-edged grafts. Rizk custom sculpts the medpor implant to fit your nose during your procedure, It is not a one size fit all implant.
Rizk usually removes the silicone implants and uses patient’s own cartilage, preferably from the nasal septum, the back of the ears or synthetic medpor in case there is not enough cartilage. Other causes include aneurysms, medications like blood thinners, diseases like autoimmune disorders or infections, conditions that cause the blood vessels to weaken, high blood pressure, stroke, tumors, or conditions like low blood platelets (which help the blood clot).
Some reconstructive rhinoplasty surgery Dr Rizk performs after cancer removal involving major flaps may take longer. Rib and septal cartilage is good for reestablishing nasal tip support because a flat strong piece of cartilage is needed. Since there are many types of cartilage piercing, the healing time can vary from three to twelve months.
Rizk examines your nose, he will make a determination regarding the best technique for you.
The most common procedure is to surgically drain the blood clot to release pressure from the surrounding tissues.
Sam Rizk is a New York Facial Plastic surgeon who is double board certified in Facial Plastic Surgery and Otolaryngology. Rizk has innovated a special technology with with micro-sanding rotating tips that smoothes and sculpts cartilage edges to eliminate the sharp-edges of rhinoplasties performed with older techniques. Types of HematomasBy far, the most dangerous type of hematoma is that which forms somewhere in the skull. If the patient has nasal obstruction, where is it and does anything make it better or worse? The skull is an enclosed space, so when a hematoma forms and creates pressure, the tissues have nowhere to go.
Lesson SummaryLet's review what I like to call 'hematoma highlights.' A hematoma forms when blood gets out of the blood vessels and clots and is most commonly caused by some type of trauma (though there are many possible causes). If symptoms are present, they usually include pain, swelling, and redness, but will vary based on where the location. Hematomas may be found anywhere on the body, though the most dangerous ones are found in the head. Minor or small hematomas usually go away on their own, but more serious ones may require surgical intervention. The bony dorsum needs to be assessed to see if osteotomies were done and if so were they done too high because Dr.
Rizk a large number of revision rhinoplasty patients with an open roof deformity and very wide bony dorsum secondary to inability to bring the bones in correctly. The internal structures of the nose need to be examined for presence or absence of a nasal septum, if it is deviated or has a perforation in it, turbinate hypertrophy, internal valve collapse or scar tissue in the internal nasal valve or between the septum and turbinates.



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