APS Aesthetic Plastic Surgery · 2011

Skoog rhinoplasty revisited

Niechajev I.

What this paper says

In 44 patients since 1997, the author removed the nasal hump, trimmed it and put it back on the bridge as a graft, obtaining a smooth bridge in nearly all cases when the graft was large enough.

Overview

After a hump is removed, thin skin can show a sharp septal edge or bone edge on the bridge. Cottle and Skoog proposed reinserting the removed hump as a smoothing graft that also preserves the nasal roof. The method fell out of use. The author reports his experience with it and discusses when it suits.

Sections of note

44 patients (29 women, 15 men) operated by one surgeon since 1997; 27 (61%) of Middle Eastern descent.
All operations under dissociative and local anesthesia.
With an adequately sized autograft, a smooth dorsal bridge was obtained in nearly 100% of cases.
In severely deviated noses, the straightened reinserted hump hid residual bending of the septum.
Smaller grafts risked visible edges and a width mismatch between the lower third of the nose and the radix after healing.
Only moderate technical changes from the original technique are used; the method is also described as a rescue when too much dorsum has been removed.

What it means for a patient

The bump that is taken off the nose can be reused to smooth the new bridge, avoiding a separate donor site.
The technique works best when the removed hump is big enough to reshape; small pieces can leave visible edges.
Results are one surgeon's assessment with no comparison group, no complication counts and no stated follow-up length.

Why this paper matters

Hump reinsertion is a precursor of modern dorsal preservation and camouflage grafting. This paper reintroduces it for thin-skinned and deviated noses and as a salvage for over-resection. Objective outcome measures and long-term graft behavior are not reported in the abstract.

Terms

Dorsal hump: the bump on the bridge formed by bone and cartilage.
Reduction rhinoplasty: surgery that makes the nose smaller, usually by removing a hump.
Autograft: tissue moved from one place to another in the same patient.
Nasal roof: the top of the bony and cartilaginous vault that is opened when a hump is removed.
Radix: the root of the nose, between the eyes.
Dissociative anesthesia: a sedated state produced by drugs such as ketamine, combined here with local anesthetic.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Accurate restoration of the smooth nasal bridge contour may be difficult to achieve after removal of the hump during reduction rhinoplasty. In patients with thin skin, a projecting septum or sharp bone edges can spoil an otherwise excellent result. To prevent dorsal irregularities from arising and to preserve the…”

Excerpt; the full abstract is on PubMed.