THE NASAL DORSUM
(BRIDGE OF THE NOSE)
The nasal dorsum, otherwise known as “the bridge” of the nose, makes up the upper 2/3 of the nose. The upper half of the nasal dorsum is made up of the nasal bones. The nasal bones are paired structures that come together to form the bony nasal vault. The lower half of the nasal dorsum is cartilaginous, consisting of the dorsal septum and upper lateral cartilage.
THE DORSAL HUMP
Excessive dorsal convexity, dorsal height, or fullness of “the bridge” can lead to the appearance of a dorsal hump. A dorsal hump refers to the appearance of a bump on “the bridge”. A dorsal hump can significantly detract from the appearance of the nose, specifically when evaluating one’s profile. A dorsal hump can be composed of bone, cartilage, or a combination of both.
Treatment of a dorsal hump involves the removal of excessive bone or cartilage to reduce the dorsal height and create a smooth appearance to “the bridge” to improve the nasal profile. Nasal profile appearance is typically based on patient preference which is discussed with patients prior to surgery.
A straight dorsal contour is typically desired by most male patients, while females typically request a straight or slightly concave contour. An overly aggressive hump reduction leading to a “scooped” or “ski slope” type appearance can cause the nose to appear very unnatural and “overdone”. While this type of look was popular in the past, it is typically frowned upon by the modern rhinoplasty surgeon.
The bony and cartilaginous components in dorsal hump reduction are addressed separately. The bony hump is typically “filed down” with specialized surgical files, otherwise known as nasal rasps. The cartilaginous hump is usually reduced with special dorsal scissors or meticulously shaved with a scalpel blade. Following large dorsal hump removal, an “open roof” deformity is typically present which will need to be addressed.
These patients underwent rhinoplasty for dorsal hump reduction to improve their profile. Note the resulting smooth character of the nasal dorsum after surgery.
Anatomic representation of a dorsal hump and the resulting smooth dorsum after hump reduction. The upper portion of the dorsal hump is composed of bone and the lower portion is composed of cartilage.