Abstract: Achieving a Balanced Nasal Profile in Patients with Pseudo-Hump: Conservative Hump Reduction and Modified Spreader Graft for Augmentation of the Dorsum and Tip

Abstract

INTRODUCTION: Correction of the hump nose entails more than just simple elimination of the dorsal hump. Recent trend is toward conservative reduction of the hump and appropriate adjustment of the radix height. East Asians often present with pseudo-hump, due to underprojected radix or tip, which accentuates the height of the hump. This study introduces our method of pseudo-hump correction and achieving a balanced nasal profile with minimal reduction of the hump and augmentation of the dorsum and tip with a modified extended spreader graft. METHODS: A retrospective review was conducted of 97 consecutive cases of Korean patients undergoing hump reduction with simultaneous augmentation of the radix with resected hump fragment, and augmentation of the nasal dorsum with modified spreader grafts with septal extension. No implants were used in any of the patients. Anthropometric analysis was performed and patient satisfaction was evaluated at postoperative 1-year. Average follow-up period was 15 months. RESULTS: Postoperatively, hump was eliminated and the dorsum and tip were successfully elevated using only autologous septal cartilage. The radix was augmented without surface irregularity or graft visibility. Nasal dorsum, tip, and radix projection, increased significantly after surgery. Subjective evaluation revealed a high level of satisfaction in 84 percent, and improvement in the rest of the patients. CONCLUSION: Our multi-purpose bilateral extended spreader graft positioned above the septal plane was effective in dorsal and tip augmentation without the need for alloplastic material. Radix augmentation was an important component of our conservative approach towards hump reduction combined with augmentation of the relatively deficient areas of the nose to produce a balanced nasal profile.