Skoog rhinoplasty revisited

Accurate restoration of the smooth nasal bridge contour may be difficult to achieve after removal of the hump during reduction rhinoplasty. In patients with thin skin, a projecting septum or sharp bone edges can spoil an otherwise excellent result. To prevent dorsal irregularities from arising and to preserve the nasal roof, the technique of autografting the reduced nasal dorsum was introduced by Cottle and Skoog. This technique was popular for a few decades but then was rarely used. Experiences with the Skoog rhinoplasty method are presented and its use in suitable cases discussed.

Since 1997, 44 patients (29 females and 15 males) have undergone surgery by the author with reinsertion of the reduced hump during rhinoplasty. Of the 44 patients, 27 (61%) were of Middle Eastern descent. All operations were performed with the patient under dissociative and local anesthesia.

Providing the autograft had an adequate size, a smooth dorsal bridge was obtained in nearly 100% of the cases. In patients with severely deviated noses, the straightened reinserted hump hid residual bending of the septum. Smaller grafts carried a risk of visible edges and an imbalance between the width of the lower third of the nose and the radix after healing. Currently, only moderate technical improvements compared with the original technique are used.

The Skoog method of rhinoplasty is worth including in the operative repertoire and can be useful in suitable cases. It also is a good rescue technique if too much of the nasal dorsum has been inadvertently removed.