Dorsal Hump Reduction With Simple Suturing

The Problem

Dorsal hump resection or reduction is one of the most commonly performed rhinoplasty procedures. Patients often present with concerns regarding a “hump” or over projection of the dorsum of the nasal vault. As such, rhinoplasty surgeons must approach hump reduction surgery with precision and a certain delicate touch to prevent many complications associated with this procedure.

The Background

The dorsum of the nose begins at the nasion and terminates at the tip defining points. It is important to consider the depth of the nasion and nasofrontal angle, as the depth of the nasion will determine if the nasal tip appears over or under projected and contributes to the appearance of the length of the nose. Generally, a deeper nasion gives the appearance of a shorter nose. Patient desires regarding variations in overall dorsal change should be respected, but there are parameters that should be considered and advised during consultation. The patient’s sex, ethnicity, aesthetic goals, and anatomy must be taken into consideration. Changes regarding significant dorsal reduction have occurred during the last 30 years, primarily related to concepts of structured rhinoplasty. Prior to restructuring techniques, significant resection of the dorsum and tip structures were the most commonly utilized techniques. Long-term follow-up of these patients demonstrated progressive loss of nasal tip and bony support, resulting in higher than acceptable revision rates, inverted V deformities, keystone instability, and contour abnormalities. Contemporary techniques are now focused on component reduction of the osseocartilaginous hump, which respects the anatomic, aesthetic, and functional relationship of the middle vault. If a septoplasty is indicated, it is important to consider performing dorsal reduction prior to performing a septoplasty as a 15 mm dorsal cartilaginous strut should be preserved. The bony dorsum can be reduced with osteotomes or rasps, and a scalpel or sharp scissors can be used to reduce the cartilaginous dorsum. Often, the upper lateral cartilages are separated from the septum, then the bony and cartilaginous dorsum can be reduced incrementally to the desired level. The excess upper lateral cartilage can then be folded or “turned in” medially to create an autospreader graft, or it can be trimmed. After dorsal reduction has been performed, it is essential to resuspend the upper lateral cartilages to the septum to prevent an inverted V deformity.

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