How much of a dorsal hump can be restored with revision rhinoplasty?

Question

Too much of my dorsum was taken off during my primary septorhinoplasty. This has left me with a slightly concave dorsum, which in my own view is less than desirable for a man's nose. Is it possible to build up the dorsum and restore convexity, and ideally, a hump in the nose? If so, what are the most viable long-term solutions for accomplishing this? In cases where the dorsum is only slightly concave, is diced cartilage wrapped in fascia a good solution to restore convexity and a dorsal hump?

Steven J. Pearlman, MD, FACS · Answer

There are a number of techniques to restore the bridge of the nose in revision rhinoplasty. These include implants (called alloplasts). I prefer your own cartilage. Rib grafts can warp. So, as you said diced cartilage wrapped in fascia is a very good choice. More recently I have changed to shaping the diced cartilage with tissue glue called Tisseal or Evicel. It allows me to precisely shape a new implant with your diced cartilage to the size and shape we choose.

Corey S. Maas, MD · Answer

Thank you for your question.  It is definitely possible to augment your dorsum and this can be achieved with a few different tools - your own nasal and septal cartilage, your ear cartilage, or your rib cartilage.  Depending on what was removed during the first rhinoplasty, you may not have enough nasal/septal cartilage in which case ear or rib would be a viable option.  Diced cartilage with fascia can also augment the nose using any cartilage that is available.  A more minimally invasive option would be with facial fillers to augment the dorsum of the nose, though this provides only temporary results.  I hope this helps and best wishes to you.

William D. Losquadro, MD · Answer

A concavity, or saddling, of the middle third of the nose defines the so-called saddle nose deformity. The bridge can be restored to any height, and a hump can certainly be added.  Cartilage grafting is the ideal method of restoring dorsal height.  If the saddle is small, septal cartilage can be used if it is still available.  For larger saddles, ear or rib cartilage is necessary.  Either can be carved as is or diced and wrapped in fascia. I prefer rib cartilage because of its volume and strength and carving it to precisely fashion the new bridge.

William Portuese, MD · Answer

Yes, it is possible to build up the bridge and even leave the patient with a slight convexity to the dorsal bridge line. Nasal cartilage is the primary source for grafting purposes  for revision rhinoplasty surgery, but the cartilage may have been removed from the previous surgery. Ear cartilage would be the next best source for grafting material.

Steven Wallach, MD · Answer

A dorsal graft of a piece of cartilage from the septum or rib might be reasonable. Diced cartilage can be used if wrapped like a burrito in temporalis fascia of thin alloderm is reasonable as well.

Michael T. Somenek, MD · Answer

It is certainly possible to rebuild the dorsum using a variety of techniques. Most of the time, some type of cartilage is used, either in a diced or crushed fashion, to augment and restore the desired contour for the dorsum. If diced cartilage is used, it can be wrapped in temporoparietal fascia. Other times, an acellular dermal matrix such as Alloderm can also be used depending on how much augmentation is required. A consultation with a revision rhinoplasty specialist will provide you with more answers to these questions.

Tae Ho Kim, MD · Answer

There are different ways to restore the shape of the dorsum of the nose.  It all depends on what was done during the first rhinoplasty operation. Without an examination, it is not possible to say what would be of benefit to you. Cartilage grafting with or without being wrapped in fascia is a good option.  However, the anatomy of the nose is complicated and, while you may be identifying one particular problem, there may be other things about the shape of your nose that may be important to address.  I would advise you to see a board certified plastic surgeon, or ENT surgeon, who has experience in revision rhinoplasty.  Good luck!

Richard W. Fleming, MD (retired) · Answer

Diced cartilage wrapped in fascia is the best treatment with permanent results to restore the bridge  whether the profile is made straight or with a slight convexity.

How much of a dorsal hump can be restored with revision rhinoplasty?

Answers (8)

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