Upper Lateral Cartilage-Sparing Component Dorsal Hump Reduction in Primary Rhinoplasty

Abstract

Dorsal hump reduction is a critical step in rhinoplasty. Most of the reasons behind revisional procedures are related to incorrect hump reduction. The authors used a modified dorsal hump reduction method in their primary cases, the steps of which are as follows: 1) dissection of the nasal vault; 2) bilateral submucoperichondrial dissections to free the cartilaginous septum; 3) separation of the upper lateral cartilages from the cartilaginous septum; 4) partial dissection of the upper lateral cartilages from the inner surfaces of the nasal bones bilaterally; 5) separation of the bony septum from the nasal bones bilaterally; 6) reduction of the partially isolated nasal bones; 7) en bloc cartilaginous and bony septum removal. The authors have operated on 68 primary cases over a 2 year period (30 mo). In the great majority of cases, the results were satisfactory. No revisions were performed in this patient group. This method is a good alternative to traditional techniques in noses with a high and narrow roof, thin skin, and weak middle nasal vault. Revision could be performed more easily when required. Initially, wide noses may not seem good candidates for this procedure; however, careful case-based preoperative planning may overcome this difficulty.