Rhinoplasty
This patient desired reversal of 2″ earlobe gauges that had been present for many years. The results are just two weeks after repair!Â
This patient desired correction of his breathing along with dorsal hump removal. He wished to preserve the shape of his nasal tip as well as the overall shape to his nose.
This patient suffered from severe nasal trauma and had lived for years with a saddle nose deformity. Dr. Spalla performed a rhinoplasty and used the patient’s own rib to create a graft to stabilize his nose both externally and internally. The postoperative pictures were taken just 8 days after the patient’s surgery.
The patient came to see Dr. Spalla due to concerns with his nose. He was having difficulty breathing through his nose and also wished to change the appearance of his nose. Dr. Spalla performed an open septorhinoplasty with cartilage grafting to achieve the patient’s goals. The postoperative pictures shown are 5 weeks after his surgery.
This patient has a rhinoplasty done by another surgeon several years before seeing Dr. Spalla. Along with aesthetic concerns, the patient couldn’t breathe through her nose, as shown in the pre-operative picture. Dr. Spalla used the patient’s rib cartilage to reconstruct her nose – improving both her form and function.
This patient came to see Dr. Spalla for a rhinoplasty. She had dorsal hump reduction and a minor tip-plasty along with alar base reduction. The post-operative base view demonstrates the well-healed incisions from the external rhinoplasty approach that was taken in this patient 2 months after surgery.
This patient presented to Dr. Spalla due to breathing concerns. He had severe obstructive sleep apnea as well compounded by difficulty breathing through his nose. Dr. Spalla recognized multilevel airway obstruction and addressed this in one surgery. The patient underwent functional septorhinoplasty with spreader grafts and turbinate reduction for his nose. He also underwent mandibular advancement (sliding genioplasty) to advance his tongue base obstruction. The post-operative pictures are taken 2 months after surgery. He had complete resolution of his severe obstructive sleep apnea as demonstrated on polysomnography and he (and his wife) loved his new jawline.
This was an extremely challenging case. The patient suffered from severe nasal trauma as a young child and that was never addressed. She was left with a complete obstruction of the left nasal passage by a deviated septum (red arrow) as well as significant external nasal deviation. Dr. Spalla performed a rhinoplasty on this patient and was able to complete relieve the nasal obstruction while improving the external nasal deviation.
Teenager presented to Dr. Spalla after an ear cartilage piercing that became infected had left her with an ear deformity. A cartilage graft from this ear was used to reconstruct the helical rim.
The post-operative (bottom) photo is just 6 weeks after repair. The patient was happy with the result and did not desire any future correction.
CO2 Laser
Facial Paralysis
This patient suffered from a complete long-standing right-sided facial paralysis. She was unable to close her right eye, so Dr. Spalla placed a gold weight implant into her upper eyelid. Additionally, given the significant asymmetry to her smile, Dr. Spalla performed a dynamic sling procedure to support the corner of her mouth known as an orthodromic temporalis tendon transfer. This was all performed through the small incision in her cheek outlined in red. The red arrow indicates the placement of the gold weight into her upper eyelid.
Orbital Surgery
This young boy presented to the emergency department due to severe eye swelling and complete blindness in the left eye. He had a complicated sinus infection that traveled to his eye resulting in intraorbital abscesses (several separate collections of pus around his eye). Dr. Spalla emergently took him to the operating room and not only performed sinus surgery to get to the source of the infection, but Dr. Spalla also opened the orbit and drained the various collections of pus around his eye. Incisions were necessary along the corner of the eye as well as through his eyelid. As you can see, the eyelid scar healed imperceptibly while there was some hypertrophy to the scar along the junction of the nose and eye. This was not unexpected as a drain was necessary in this area for nearly 2 weeks while the infectious disease team helped manage his infection. Thankfully, the child had a complete return of his vision! He went from blind to 20/20 vision and saw Dr. Spalla in follow-up for several more years.
Skin Cancer
This patient presented with an advanced and aggressive basal cell carcinoma. Given the extent of this, he was not a candidate for Mohs surgery. Dr. Spalla performed a wide local excision of this along with a superficial parotidectomy and closed the entire defect in one sitting with a cervicofacial advancement flap. The patient did not wish to have any further revisions performed. He remains cancer free.
Tumor
This patient came to see Dr. Spalla due to a right facial vascular malformation. Given its location, she was turned away by several other surgeons due to the risk of the surgery. She wanted to have this gone prior to her wedding. Dr. Spalla removed the entire tumor through a well-hidden incision in her nasolabial fold in time for her wedding. She was thrilled to have this done in time for her wedding and didn’t desire any additional procedures.
Blepharoplasty
This patient presented to Dr. Spalla for an upper blepharoplasty due to a visual field defect. The preoperative picture demonstrates her heavy upper eyelids hanging over her eyelashes. The postoperative picture, taken just 5 days after surgery, reveals a more open eye without the heavy lids hanging on her lashes.
Wound
This patient was referred to Dr. Spalla after Mohs surgery for basal cell carcinoma of the left cheek. After presenting the patient with surgical options for immediate closure, the patient opted not to have anything done. Dr. Spalla performed wound care with the patient and saw him back regularly to ensure proper healing was occurring. Results shown are 10 weeks after the initial wound and demonstrate that even select large wounds can have good results if cared for properly. The patient did not want anything further done and was happy with the final appearance.
This patient was referred to Dr. Spalla by a Mohs dermatologist after extensive surgery was necessary to cure her of basal cell carcinoma. The patient opted for surgery which Dr. Spalla performed in a staged fashion. During the first portion of the procedure, Dr. Spalla performed a forehead flap to her nose, ear cartilage grafting to her nasal tip, complex rotational flaps inside her nose, and a septal hinge flap for support of her dorsum and tip. During the second surgery, about 3 weeks later, the intranasal flaps and forehead flaps were inset. The patient was happy with the results and didn’t desire future procedures for any contouring or hair removal.
This patient suffered a dog bite to her nose and cheek. She was repaired in the emergency department, and saw Dr. Spalla many months later to improve the scarring. Dr. Spalla performed a few rounds of steroid injections followed by a minor scar revision surgery to improve the thickness and shape of the scar.
