Dorsum Reconstruction and Osteoplasty Using Hand Instruments

The Problem

Dorsum reduction and reestablishment of dorsal aesthetic lines is one of the most important steps of rhinoplasty operation. A meticulous dissection of the upper lateral cartilages (ULC) and nasal bones is crucial to achieving an aesthetically pleasing nasal dorsum and avoiding dorsal irregularities. This is especially important in the keystone area, where the caudal portion of the nasal bones overlaps the cephalic portion of the ULC. Dissection of this area is rather difficult due to the complex anatomy, and extra care should be taken to avoid postoperative deformities. The open rhinoplasty approach provides better visualization of nasal dorsum anatomy and easier execution of maneuvers.