Front view change after rhinoplasty procedure removing the hump

Question

I see a lot of pre and post rhinoplasty pictures and very often notice that with a procedure where hump is removed and droopy tip repositioned the profile always looks amazing whilst the front view changes for the worst in some patients. When I say for "the worst" I mean the overall face seems more attractive from the front prior to the procedure ... why is this happening? Opinions much appreciated. Thank you!

Patrick Simon, MD · Answer

You are likely appreciating that the nose appears wider on frontal view. You must remember that nose and hence rhinoplasty is an intervention taking place in 3 dimensions.  By reducing a hump you are bringing the depth of the nasal bridge down to a wider area, like taking the top third off of a pyramid.  You potentially disturb functional aspects of the nose in doing this (i.e. obstructing nasal breathing).  In response to this change spreader grafts are often placed to maintain the patency of the nasal airway.  An unfortunate side effect of this is widening of the middle third of the nose.  The happy balance is maintaining the improved aesthetic without compromising function.Additionally, while you are evaluate preop-postop pictures consider that while the profile view often is the most dramatic postoperative view, it is really only a 2 dimensional portrait of the nose, and likely only tells part of the story. The 3/4 view or the oblique view is the most true-to-life view and the most aesthetic view of the nose.

Peter Callan, MBBS, FRACS, MBA · Answer

You are absolutely correct.  The front and side views must both be seen.  People know themselves from the front, but often it's photos where they notice the side view.  The front view is the hardest to get absolutely perfect, but is the key to a good rhinoplasty.  The reasons for this are many, but include the dorsal aesthetic lines, tip parameters including the shape of the nostrils and part under the tip.It's a book chapter in itself.    You have inspired me to write more about this and I will do so in the future.  It's a key observation.I hope this helps, and I will write more in the coming moths with some diagrams.

Jawed Tahery, FRCS · Answer

Thankswhilst the biggest impact removal hump have on profile view, the effect on frontal view is not as noticeable but I haven't been given this feedback by my patients !BWJ TaheryOtolaryngologist/Facial Pladtic SurgeonChesterUK

Somyos Kunachak, MD - Account Suspended · Answer

Hi Nukanu,After hump removal, there is always a risk of open roof deformity, making the bridge appear broad if not corrected simultaneously. Inadequate bone work may also make the front view ofthe nose look flat.

Dennis Barek, MD (retired) · Answer

Frequently after hump removal and osteotomies, there is collapse of the internal valves causing an "inverted V"deformity with pinching of the cartilaginous dorsum with airway dysfunction.This requires spreader grafts to have been placed before the end of the procedure. They can be placed at a revision if needed

Front view change after rhinoplasty procedure removing the hump

Answers (5)

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