Management of the wide nasal dorsum

The literature is replete with discussions outlining surgical techniques for managing nasal tip deformities. In contrast, articles devoted to specific dorsal nasal abnormalities are rare. Surgical management of the nasal dorsum has traditionally been relegated to either augmentation or reduction followed by osteotomy. Contemporary rhinoplasty demands attention to the creation of an ideal profile line, which may require dorsal reduction in some areas and augmentation in others. Treatment of the patient with an appropriate projection of the profile but with a wide nasal dorsum presents a special challenge: to narrow the nasal bridge without altering its projection. We discuss several surgical techniques to narrow the nasal dorsum, while maintaining dorsal height. Selected cases are presented to illustrate these techniques and to clarify surgical options.