There are various types of unattractive noses, and the hump nose is one of them. A hump nose can significantly impact one's facial appearance. So, what does the surgical process for correcting a hump nose entail? Regarding this question, let our expert explain below.
1) Incision. Internationally, intranasal incisions are commonly used, though the procedure is performed without direct visualization, making it technically challenging. Domestically, external incisions are preferred due to their advantages of ample exposure and ease of manipulation, though they may leave a scar on the nasal tip.
2) Subcutaneous Dissection.Using a curved scissors, dissect all movable and fixed components of the nasal dorsum. This involves separating the alar cartilage, lateral nasal cartilage, and upper portion of the septal cartilage from their overlying skin. Subsequently, use a periosteal elevator to separate the nasal bone from its overlying periosteum, muscles, and skin, while also separating it from the underlying mucosa. Superficial dissection extends: superiorly to the nasal root, and laterally to the maxillary frontal process.
3) Resection of the hump. Resect the pre-marked protruding nasal bone and lateral nasal cartilage using a bone chisel, then smooth the surface with a bone rasp. Alternatively, bone scissors may be used to remove the hump.
4) Narrowing the nasal dorsum.Using a periosteal elevator, separate the maxillary frontal process from its overlying periosteum and soft tissues. Then, using an electric or pneumatic reciprocating saw or bone chisel, saw through the maxillary frontal process at the nasofacial junction while simultaneously making a transverse cut through the bone tissue above the nasal bone. The cut should be made as close as possible to the origin of the maxillary frontal process to prevent step formation.If a step forms, partially resect the bone to eliminate it, then push the maxilla toward the midline with the thumb. If the patient's nasal base is not wide, Skoog's technique may be employed: remove the superficial layer of the excised hump for reuse in grafting the nasal dorsum, or implant a thin silicone nasal splint to shape the nasal bridge.
5) Correct lower nasal deformities. If accompanied by excessive lower nasal length, dissect the distal end of the lateral nasal cartilage and resect an appropriate portion. For nasal tip drooping, resect a suitable segment of the anterior septal cartilage behind the medial crus of the alar cartilage, then suture the columella and septum along the resection margins.For cases with concomitant alar hypertrophy, resect portions of the superior and lateral margins of the alar cartilages. If the nasal tip is excessively low, use the excised nasal bone or cartilage for augmentation and support.
6) Postoperative fixation. Proper fixation is crucial during hump nose correction. Correct fixation preserves the intended surgical outcome, while improper fixation may compromise results or cause secondary deformities. Therefore, the principle of fixation is to apply uniform pressure both inside and outside the nose to maintain the designed aesthetic shape and prevent secondary deformities.