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Typical Asian deformed nose has many different types: concave nasal dorsum, low nasal dorsum, wide nasal dorsum, deviated nose, convex nasal dorsum, saddle nose, short-nose deformity, and deformities involving irreversible damage of skin/soft tissue envelop are the most representative ones. The key concept in Asian rhinoplasty is augmentation in all different forms of nasal deformities. Augmentation of the nose consists of framework, tip, and dorsal augmentation. Septal extension grafting and tip grafting are 2 maneuvers with profound importance in augmentation of lower two-thirds of the Asian nose. Dorsal augmentation is central concept in beautifying all different types of deformed noses, even the hump nose.

Both deviation and excessive width of the nasal dorsum result in conspicuous facial disharmony and are often attended by nasal airway dysfunction. Whether the result of developmental growth disturbances, nasal trauma, failed nasal surgery, or combinations therein, deviation and splaying of the nasal dorsum can be exceedingly difficult to treat. Individualized treatment is paramount because contour variations are seemingly endless, and a careful preoperative assessment of the anatomic, physiologic, cosmetic, and psychosocial factors that characterize the deformity is necessary to devise an effective patient-specific treatment plan. Ensuring the linearity, strength, alignment, and aesthetically pleasing profile dimensions of the nasal L-strut is the requisite first step in successful treatment. Releasing all deformed components in a controlled and precise manner using powered instrumentation (whenever possible) to facilitate minimally traumatic and effective repositioning, followed by structural reconstitution of the skeletal framework using autologous graft materials, and then consolidation of the newly created construct with suture fixation completes the transformation to normalcy. Paying equal attention to both cosmetic and functional wellness, while simultaneously seeking to maximize structural stability, serves to optimize the final outcome.

The middle vault is a transition zone between the nasal tip and nasal bones and plays an important role in profile, tip projection, tip rotation, and tip support. This report presents an alternative to conventional techniques specific to the middle nasal vault for a patient population with particular nasal features. A narrow middle vault with internal nasal valve collapse is functionally and aesthetically addressed by the insertion of spreader grafts. However, the inverse of this situation is sometimes encountered. A patient with a broad middle vault and without internal nasal valve collapse will benefit from reduction of the horizontal width of the cartilaginous dorsum, which is in effect the reverse of spreader grafts. This effect is achieved by excising a vertical wedge-shaped strip of cartilage that follows the length of the upper lateral cartilage at the junction of the upper lateral cartilage and the dorsal nasal septum.

The operative procedure frequently used to narrow the nasal pyramid in the context of a regular rhinoplasty is well known to all rhinoplastic surgeons. It consists of hump removal, followed by lateral osteotomies and medialization of the nasal bones. However, narrowing of a wide nasal pyramid, in the absence of an appreciable dorsal hump, as in the case of an ideal dorsal height or a mild hump, presents a different challenge. The present article describes a simplified approach to the 'nasal plateau resection', a technique that allows the creation of an open nasal roof, without hump removal and without compromising dorsal projection. This permits the medialization of the lateral nasal bones and the subsequent narrowing of the wide pyramid, while preserving the height of the nasal dorsum as viewed in profile.L’intervention chirurgicale souvent utilisée pour réduire la largeur de l’arête du nez dans le contexte d’une rhinoplastie standard est bien connue de tous les rhinoplasticiens. Elle consiste à éliminer la bosse, puis à pratiquer des ostéotomies latérales et une médialisation des os du nez. Par contre, diminuer la largeur de l’arête du nez en l’absence de bosse appréciable, comme dans le cas d’une hauteur de nez idéale ou d’une bosse minime, représente un défi considérable.Le présent article décrit une approche simplifiée à la « résection du plateau nasal », une technique qui permet de créer une voûte nasale ouverte, sans ablation de bosse et sans altération de la projection dorsale. Cette approche permet la médialisation des os latéraux du nez et la diminution subséquente d’une pyramide large, tout en préservant la hauteur de l’arête du nez vue de profil.

Objective Rhinoplasty is arguably the most challenging of all facial aesthetic surgery. With contemporary aesthetic ideals favoring the more petite and narrow nose, successful management of the wide nasal dorsum is crucial in obtaining favorable outcomes. This paper aims to define the underlying anatomical variances that contribute to the wide nose, as well as providing a process by which one can identify and address these components appropriately. Study Design and Setting We conducted a retrospective study of 543 consecutive rhinoplasty patients presenting to a busy inner city cosmetic practice in Sydney, Australia. Of these patients, 53 were identified whose primary complaint was dissatisfaction with their wide nose. Analysis of the fundamental causes for these patients’ wide nasal dorsum was carried out, and the techniques used to manage these problems were tabulated. Two illustrative case studies are included. Results Of the 53 patients, 29 (54.7%) could be managed by the simple technique of single lateral osteotomies in conjunction with medial osteotomies or hump removal. In the remainder, a variety of techniques were required to achieve the desired result. These included multiple lateral osteotomies (32.1%), wedge osteectomies (11.3%), nasal bone sculpturing (1.9%), reverse spreader technique (1.9%), cartilage sculpturing (3.8%), dorsal onlay grafting (22.6%), and deep fatty panniculus excision (35.8%). Conclusions Management of the wide nasal dorsum should begin with a comprehensive analysis of the underlying causative anatomy. Although most cases may be managed satisfactorily with simple lateral osteotomies, a large percentage of patients presenting to the rhinoplasty surgeon will require adjunctive or alternate techniques to produce optimal results.

The literature is replete with discussions outlining surgical techniques for managing nasal tip deformities. In contrast, articles devoted to specific dorsal nasal abnormalities are rare. Surgical management of the nasal dorsum has traditionally been relegated to either augmentation or reduction followed by osteotomy. Contemporary rhinoplasty demands attention to the creation of an ideal profile line, which may require dorsal reduction in some areas and augmentation in others. Treatment of the patient with an appropriate projection of the profile but with a wide nasal dorsum presents a special challenge: to narrow the nasal bridge without altering its projection. We discuss several surgical techniques to narrow the nasal dorsum, while maintaining dorsal height. Selected cases are presented to illustrate these techniques and to clarify surgical options.

• This article introduces the use of the familiar rotating burr for surgery of the nasal dorsum and focuses on three aspects—surgery of the fronto-nasal angle, narrowing of the wide nasal dorsum, and augmentation of the nasal dorsum by autogenous bone grafts. External rhinoplasty provides the necessary visualization to permit the use of the rotating burr. ( Arch Otolaryngol 1981;107:436-438)