Managing the Dorsum in Rhinoplasty
07 April 2017 (online)
Rhinoplasty has and likely always will be one of the most challenging operations in plastic surgery. One could argue that few operations combine the technical challenges of maintaining or restoring the often inimical needs of form and function, aesthetics, and physiology. Surgery of the nasal dorsum is no exception in this regard.
The role of the nasal dorsal profile in facial aesthetics is quite clear. Indeed, the very first rhinoplasty operations were attempts to reduce the dorsal hump. Legend has it that one of the first rhinoplasty operations was performed in the 15th century by the Duke of Urbino (Federico da Montefeltro) on himself, clearly visible in the famous panel by Piero della Francesca, on display at the Uffuzi gallery in Florence, Italy ([Fig. 1]). He removed a section of his nasal bridge not for aesthetics, but rather to see over his large nasal bridge (he was blinded in one eye in a tournament accident).
Today, we modify the dorsum both by reduction and by addition. Creation of a pleasing nasal dorsum, like much of aesthetic rhinoplasty, involves creating a continuous, uninterrupted form whose highlights and shadows are harmonious with the rest of the face. This is more than a profile—it is symmetry and shape on frontal view, edge highlights on the three-fourth view, and height and proportion on the true profile view.
Rhinoplasty is an operation that requires us to keep learning from both our own experiences and those of others. In this issue, I have gathered some of the world's experts in rhinoplasty to discuss various issues regarding the complex problems in surgery of the nasal dorsum. I hope you find their shared experiences helpful in improving your patients' outcomes in this most challenging operation. We have come a long way since the time of the Duke of Urbino, but we must keep pushing ourselves to do better.