High or Prominent Dorsum in Rhinoplasty

The high or prominent dorsum may be successfully corrected with Dr Steve Byrd"s rhinoplasty techniques using computer imaging as a guide.

One of the most common complaints among rhinoplasty patients is a bump or hump on the bridge of the nose. A good deal of aesthetic leeway exists in establishing the desired dorsal profile. I begin by determining the ideal tip projection for the nose and the ideal projection at the nasal radix (see analysis). From here computer imaging helps most patients decide on the final dorsal profile. It ranges from preserving a slight bump or fullness at the junction of the bony and cartilaginous bridge, to a straight profile line from the radix to the tip of the nose, to a slight retrousse where the profile line drops 2 mm below the projection of the nasal tip. I discourage a "ski slope" configuration as it creates a very "done" or operated look.

Patients almost always ask me what looks the best. When we did our nasal analysis study on models (Byrd HS,et al: Rhinoplasty: a practical guide for surgical planning. Plast Reconstr Surg 91(4):642, 1993), those with a slight retrousse and supratip break scored slightly higher than others, but needless to say there where many beautiful noses and faces with straight dorsal profiles. I find other facial features to be a useful guide. Specifically, individuals with strong angular features do well with stronger nasal profiles. This also true of most male faces.