Facial plast Surg 2011; 27(2): 192-202
DOI: 10.1055/s-0030-1271299
© Thieme Medical Publishers

Management of the Nasal Dorsum

Jonathan M. Sykes1 , Vanesa Tapias2 , Ji-Eon Kim1
  • 1Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of California, Davis, Sacramento, California
  • 2Pontificia Univerdidad Javeriana, Bogota, Colombia
Further Information

Publication History

Publication Date:
14 March 2011 (online)


Profile alignment, including nasal dorsal reduction, is one of the most common maneuvers in aesthetic rhinoplasty. Techniques often include cartilaginous excision and bony hump reduction with a chisel or a rasp. Cartilaginous nasal vault excision can result in separation of the junction between the upper lateral cartilages and the dorsal septum. This separation can cause an inferior-medial repositioning of the upper lateral cartilages and overall weakening of middle vault infrastructure. Furthermore, surgical interruption of this key region can also damage the internal nasal valve configuration and function and create static and dynamic airway obstruction. This article outlines the anatomy and function of the middle nasal vault and internal nasal valve. In addition, it provides an overview of aesthetic complications of dorsal hump removal including inverted-V deformity, saddle nose deformity, hourglass deformity, and their functional consequences. Preoperative individual risk factors for middle-third deformities are mentioned. Preventive and corrective surgical techniques including cartilage grafting and reconstructive sutures are also detailed.