Reinserting the Hump in Primary Rhinoplasty

The Gain Is Three-Fold

Jannis Constantinidis, PhD; Georgios Fyrmpas, MSc, PhD


Plast Reconstr Surg Glob Open. 2016;4(10):e1021 

In This Article


Hump reduction in primary rhinoplasty destabilizes the middle vault. Further maneuvers are necessary to prevent long-term middle vault collapse and its functional and aesthetic sequelae. The combination of the modified hump reinserted between the ULs and bridging sutures is a middle vault–preserving technique that has not been described before. The autograft prevents the inward collapse of the ULs and provides a smooth and natural nasal neodorsum. The sutures prevent displacement of the autograft and increase the nasal valve angle should it be necessary. The technique does not require an open approach in the majority of cases, thus permitting less soft-tissue dissection and scarring and reduced operative time. Noses with a large hump and long noses with thin skin and short nasal bones that would otherwise need an open approach and spreader grafts may alternatively be managed with this technique.