An overly prominent nasal dorsum with a hump of bone and/or cartilage is one of the defects that patients most frequently seek to correct. Lowering of the line of the profile must be carried out gradually and sparingly for both male and female patients in order to avoid going beyond the boundaries of the ethnic models and creating an unnatural nose. A depressed nasal profile would clash with strong and resolute features, for example, whereas one that is slightly concave and upturned goes very well indeed with fine and delicate features. It is interesting to note in this connection that a straight nose is most in demand with patients today, rather than the concave “French nose” that was in vogue a few years ago. Establishing balance in profile between the bridge and tip of the nose is the most delicate phase in rhinoplasty. The factors essential to an excellent result comprise knowledge of the patient’s expectations, prevention of the tip from drooping over time, and harmony between the projection of the tip and the line of the bridge.

In this case, the patient essentially requested a smaller nose of natural appearance in harmony with the rest of her face.

Preoperative analysis revealed a slight osseous hump and drooping tip. The nose was too long and unacceptably large in size. The utmost care was taken during the operation not to overdo the removal of structures and to create a nose in harmony with the face without altering its Mediterranean characteristics.

This patient presented a particularly crooked nose with a very evident hump in the middle of the dorsum. She was concerned above all to obtain a straight and natural profile.

Rhinoplasty was carried out by means of the open approach with removal of the hump and reshaping of the nasal tip. The positioning of a spreader graft on the left side of the dorsal septum brought the deviated nasal pyramid back onto the median line. (The patient was operated on in live surgery during the 7th edition of the Naso e Dintorni course in 2007).

This young patient complained of a particularly prominent nasal dorsum and above all a drooping, bulbous tip.

In addition to the dorsal hump, preoperative analysis revealed a nasal tip with no projection and very little rotation. Rhinoplasty performed with the open approach gave the patient a straight profile and a nasal tip with the right degree of projection and rotation, in harmony with the line of the bridge. This case was published in my article ‘Mini-Spreader Graft: a New Technique Associated with Reshaping of the Nasal Tip,’ Plastic and Reconstructive Surgery, 2005, 116(5), pp. 1525–34.

The patient wanted the small hump on the dorsum to be removed and the nasal tip to be slightly “softened” and rotated.

Rhinoplasty performed with closed approach eliminated the blemishes as requested by the patient so as to focus attention no longer on her nose but other very beautiful features such as her eyes and lips.

The patient complained about a hump on the nasal dorsum as well as a large, drooping tip.

The patient complained about a hump on the nasal dorsum as well as a large, drooping tip. The preoperative analysis has highlighted that the actual issue was the tip,that was not projected and not rotated upwards enough, more than the hump. An open access rhinoplasty has successfully allowed the correct rotation of the tip and its projection, while the reduction of the hump was minimal and actually not crucial to achievement of the desired result. The nasal tip was also reduced in width with a few internal intracartilaginous sutures.