Composite Hump Resection

The Problem

Excessive dorsal nasal convexity (large)

The Background

One of the most common concerns in cosmetic rhinoplasty is a large dorsal hump. It is the most easily identified by the surgeon, the patient, and the public as an unaesthetic appearance. The hump is defined as the dorsum of the nose from the most superior point of the nasal bones that begin to extend above the desired dorsal line to the junction of the anterior–inferior tip of the nasal septum and extend laterally to include that portion of the nasal bone, upper lateral cartilage, and dorsal septum that protrudes above the newly desired dorsal line on a profile view. Thus, removing a hump at the time of rhinoplasty is one of the most frequently performed parts of the rhinoplasty. The technique of how this step is performed is based on the hump’s size, patient’s preference, and experience of the operator. There are essentially two ways to remove the hump: composite removal or stepwise removal. Halewyck et al. reviewed nasal dorsal hump reduction techniques, with a particular emphasis on a comparison of component and composite nasal dorsal hump removal. The description of a safe way to remove the hump in a composite resection will be described in this chapter.

The Indications

In order to reach the aesthetic goals of the rhinoplasty, the nasal dorsal hump will have to be removed. The technique that has been used by the author for many years for removal of large humps using the composite approach will be described. Adding a safety step using Joseph saws should make composite removal of the large hump a very useful and safe maneuver.

The Patient