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.

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

Answers (8)

Answer: Revision Rhinoplasty to build up the bridge

Answer: Revision Rhinoplasty to build up the bridge

Answer: Dorsal graft

Answer: Dorsal graft

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Everything you need to know about Revision Rhinoplasty

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

Answers (8)

Answer: Revision Rhinoplasty to build up the bridge

Answer: Revision Rhinoplasty to build up the bridge

Answer: Dorsal graft

Answer: Dorsal graft

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Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.