title: Reconstitution of the nasal dorsum following component dorsal reduction in primary rhinoplasty.
abstract: BACKGROUND
  Dorsal hump reduction can lead to significant aesthetic and functional deformities if one does not preserve and subsequently restore proper position of the upper lateral cartilages. The senior author (R.J.R.) previously described the component dorsal hump reduction to preserve the integrity of the upper lateral cartilages, thereby avoiding routine use of spreader grafts. In this study, the authors introduce their algorithm for reconstitution of the nasal dorsum.
  
  
  METHODS
  The charts of 100 consecutive primary rhinoplasty patients from the senior author's practice were reviewed. The technique used for dorsal reconstitution, complications, and revisions were analyzed. Preoperative and postoperative images of the dorsal aesthetic lines were examined for symmetry and contour.
  
  
  RESULTS
  Mean follow-up was 19 months. A dorsal hump reduction of 5 mm or more was performed in 39 patients (39 percent). No patients received spreader grafts. The technique used for dorsum reconstitution was upper lateral cartilage tension spanning suture (type 1) in 65 percent, reapproximation (type 2) in 25 percent, and spreader flaps (type 3) in 10 percent. There were no significant complications and 4 percent required revision. Dorsal aesthetic lines were symmetric in 69 patients (69 percent) preoperatively and in 94 patients (94 percent) postoperatively. The authors found 65 dorsal aesthetic lines (32.5 percent) without contour irregularities preoperatively compared with 194 (97 percent) postoperatively.
  
  
  CONCLUSIONS
  Reconstituting the nasal dorsum with repositioning of the upper lateral cartilages that is based on the individual anatomy of the rhinoplasty patient can provide durable cosmetic and functional results without the need for routine use of spreader grafts.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
authors.forename: Jason
authors.initials: J
authors.lastname: Roostaeian
authors.forename: Jacob G
authors.initials: JG
authors.lastname: Unger
authors.forename: Michael R
authors.initials: MR
authors.lastname: Lee
authors.forename: Palmyra
authors.initials: P
authors.lastname: Geissler
authors.forename: Rod J
authors.initials: RJ
authors.lastname: Rohrich
mesh_terms: D000293:Adolescent; D000328:Adult; D006801:Humans; D008875:Middle Aged; D055171:Nasal Cartilages / Q000601:surgery*; D009666:Nose / Q000601:surgery*; D012225:Rhinoplasty / Q000379:methods*; D055815:Young Adult