The wide nasal dorsum: evaluation and management

Rhinoplasty is arguably the most challenging of all facial aesthetic surgery. With contemporary aesthetic ideals favoring the more petite and narrow nose, successful management of the wide nasal dorsum is crucial in obtaining favorable outcomes. This paper aims to define the underlying anatomical variances that contribute to the wide nose, as well as providing a process by which one can identify and address these components appropriately.

We conducted a retrospective study of 543 consecutive rhinoplasty patients presenting to a busy inner city cosmetic practice in Sydney, Australia. Of these patients, 53 were identified whose primary complaint was dissatisfaction with their wide nose. Analysis of the fundamental causes for these patients' wide nasal dorsum was carried out, and the techniques used to manage these problems were tabulated. Two illustrative case studies are included.

Of the 53 patients, 29 (54.7%) could be managed by the simple technique of single lateral osteotomies in conjunction with medial osteotomies or hump removal. In the remainder, a variety of techniques were required to achieve the desired result. These included multiple lateral osteotomies (32.1%), wedge osteectomies (11.3%), nasal bone sculpturing (1.9%), reverse spreader technique (1.9%), cartilage sculpturing (3.8%), dorsal onlay grafting (22.6%), and deep fatty panniculus excision (35.8%).

Management of the wide nasal dorsum should begin with a comprehensive analysis of the underlying causative anatomy. Although most cases may be managed satisfactorily with simple lateral osteotomies, a large percentage of patients presenting to the rhinoplasty surgeon will require adjunctive or alternate techniques to produce optimal results.