Reconstitution of the nasal dorsum following component dorsal reduction in primary rhinoplasty

Roostaeian J, Unger JG, Lee MR, Geissler P, Rohrich RJ.

What this paper says

In 100 consecutive primary rhinoplasties with no spreader grafts, the upper lateral cartilages were repositioned after hump removal by a spanning suture (65%), direct reapproximation (25%) or spreader flaps (10%), giving symmetric dorsal lines in 94% at a mean 19 months with a 4% revision rate.

Overview

Removing a hump detaches the upper lateral cartilages from the septum; if they are not put back correctly, the middle of the nose narrows and breathing suffers. Spreader grafts are the usual fix. The senior author (R.J.R.) removes the hump in components to keep those cartilages intact and presents an algorithm for restoring them without routine spreader grafts.

Sections of note

Chart review of 100 consecutive primary rhinoplasty patients from one practice; mean follow-up 19 months.
Hump reduction of 5 mm or more in 39 patients.
No patient received a spreader graft.
Reconstitution method: upper lateral cartilage tension spanning suture (type 1) 65%; reapproximation (type 2) 25%; spreader flaps (type 3) 10%.
No significant complications; revision in 4%.
Dorsal aesthetic lines symmetric in 69% before and 94% after surgery.
Lines without contour irregularity: 32.5% before, 97% after.
Level of evidence: therapeutic, IV.

What it means for a patient

Hump removal does not always require cartilage grafts to keep the middle of the nose open; repositioning the existing cartilage worked in this series.
The choice of method depends on the individual anatomy and how much hump is removed.
One surgeon's results; breathing outcomes were not measured in the abstract, and follow-up averaged under two years.

Why this paper matters

It challenges the routine use of spreader grafts after hump reduction and provides a graded alternative. Long-term airway data and results in other surgeons' hands are not available from this paper.

Terms

Component dorsal reduction: removing a hump in stages, cartilage and bone separately, to keep the upper lateral cartilages intact.
Upper lateral cartilages: the paired cartilages forming the sides of the middle third of the nose.
Spreader graft: a cartilage strip placed between the septum and upper lateral cartilage to hold the middle vault open.
Spreader flap: the upper lateral cartilage folded inward to act as its own spreader.
Tension spanning suture: a stitch across both upper lateral cartilages and the septum that resets their position.
Dorsal aesthetic lines: the paired curved highlights along the bridge seen from the front.

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

From the abstract

“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…”

Excerpt; the full abstract is on PubMed.