Dorsal Refinement Information Miami
Dorsal Refinements with Miami Plastic Surgeon, Dr. Bared
A key component to many rhinoplasty surgeries is the proper refinement of the bridge and the proper alignment of the dorsum. Understanding to the anatomy of this area provides for more predictable results in rhinoplasty. The nose is only 1/3 bone. Cartilage makes up the majority of the structure of the nose. The proper reduction of the dorsum in patients with a dorsal hump is by no means easy. Oftentimes, patients have the impression that this procedure is as easy as “shaving off the hump,” as Dr. Bared often hears. However the proper degree of hump reduction is more challenging than the simple shaving of the bone. Hump reduction requires an appreciation for how much of the hump is composed of bone versus cartilage. It also entails understanding how the degree of skin thickness contributes to the hump.
The thickness of the skin over the nose actually varies even within the nose iself—being thinnest where the cartilage meets the bones at the rhinion and thickest in the supratip area and radix. Lastly, what appears straight on the operating room table may not result in being straight after the nose heals months after surgery. All these variables are not meant to scare the rhinoplasty patient, but rather to give them an appreciation for the degree of expertise they need to be seeking in their rhinoplasty surgeon. The rhinoplasty surgeon needs to treat even what may seem to be the most straightforward aspect of the surgery with great attention and respect. The surgical technique employed must be one in which the surgeon is comfortable and produce the most reliable results in their hands.
The bridge and dorsum compose a three dimensional structure. By reducing a hump, you are actually temporarily making the bridge wider. Dr. Bared often uses the analogy of a steeple roof, if you chop the top off the roof the sides of the roof remain. These sides are now wider than the original structure, thus in order to narrow the roof the sides need to be brought in. The same can apply to the nose. If a hump is removed the sidewalls of the nose need to be brought in. If they are not adequately brought in the deformity is referred to as an “open roof deformity.” The side walls of the nose are brought in by the precise cutting and fracturing of the bones. As was mentioned, the nose is only composed of 1/3 bone.
The majority of the nose is cartilage. Therefore, when reducing a hump in most cases what is being reduced is cartilage and not bone. In order to account for the cartilage that has been removed and to avoid depressions in the middle vault area which can ensue months after surgery, Dr. Bared may place what are referred to as spreader grafts in this area. Spreader grafts serve the purpose of helping prevent depressions in the middle vault particularly in patients with shorter nasal bones and thinner nasal skin. These patients are more at risk for what is known as an inverted ‘V’ deformity. In some cases the appearance of a hump is not so much related to an actual hump but rather to a poorly projected nasal tip and radix (root of the nose). In these cases, the actual hump “reduction” entails the augmentation of the radix and the projection of the tip.
The degree of lowering of the hump varies from individual to individual. Some patients prefer a straighter appearing dorsum while others desire to see a slight scoop. In order to appreciate the differences Dr. Bared provides computer imaging to help you better “see” the potential result. The degree of lowering of the dorsum can then be tailored to each individual case bearing in mind that there exists variations between the imaged photos and the actual results.