Dorsal Hump Reduction and Midvault Reconstruction

A dorsal hump is one of the most commonly cited patient concerns when presenting for aesthetic evaluation of the nose. And although dorsal hump reduction is one of the most basic technical goals, history has proven that a great many technical nuances exist explaining a relatively high secondary revision rate. Effective dorsal hump reduction requires an appreciation for aesthetic ideals, mastery of nasal anatomy and physiology, thorough preoperative patient evaluation, and an understanding of each surgical maneuver as well as its secondary effects on the nose. These must be anticipated and addressed at the time of the index operation to prevent untoward sequelae that can be very distressing to patients. Component dorsal hump reduction allows for a tailored approach to each individual nose, where each maneuver can be performed with precision and control. Adequate reconstruction of the midvault is paramount to preventing many of the undesirable effects of rhinoplasty, including further aesthetic and functional deformities. The last several decades have far expanded the options for reconstruction of the midvault, including spreader grafts and spreader flaps, each with many modifications that can be catered to every type of nose. Comprehensive understanding of these concepts will allow for effective dorsal reduction that results in great patient and surgeon satisfaction.