To restore the shape of the nose and replace the tissues that resorbed from the trauma and the hematoma plan was made to take a costal cartilage graft and patient informed and consent secured for the procedure. the team decided to not harvest the costal graft before trail a less invasive ways to restore the shape ,starting by median osteotomy + very low lateral osteotomy to restore the nasal hump and improve the dorsum of the nose, proline sutures taken at lower part of the dorsum to avoid haematoma formation dissection of the nasal septum and trails to utilize it in support of the tip or take a graft from it to make graft over part between upper and lower lateral ,but the cartilaginous septum was deficient, small conchal graft taken from the RT concha and fixed over the cartilaginous area to cover the groove for flaring of the both allar cartilage, resection of the medial parts of the lower lateral cartilage and suturing the lower lateral cartilage together for define the tip  collumellar strut also done for nasal tip support As a general role ,choosing less invasive procedure is more preferred than the complicated multi steps operations, and if the surgeons can save time and patients tissues and use only tissues available in the same region and also reach to his aesthetic goal In this case instead of harvesting costal cartilage graft to restore the defected tissues in the dorsum of the nose ,only median osteotomy and very low lateral osteotomy done for him and it restore the dorsum and give patient a very good result , also harvesting small conchal graft for coving the groove in the cartilaginous part of the nose giving a very good result . Flaring of the both alla improved by only resection of the tissues of lower lateral cartilage and giving an accepted result for the nasal tip definition Very low osteotomy and median osteotomy can restore defect in nasal dorsum without need for costal cartilage graft, utilizing a small conchal graft is effective in covering major groove between upper and lower lateral cartilage.

TBA