Flat dorsum

The nose is made up of a fixed and rigid part that is called nasal pyramid, although it rather has the shape of a tent or roof, and a pliable mobile part which is the nasal tip, the alae and its annexes. The nasal pyramid is formed by two types of structures or tissues; in the most cephalic or upper part the nasal pyramid is formed by the nasal bones and the ascending process of the maxilla, that is, by bone tissue; the most caudal or lower part of the nasal pyramid is formed by the triangular cartilages or also called quadrangular or lateral or upper lateral, that is, by cartilaginous tissue.

Both halves or walls of the nasal pyramid join and fuse horizontally with each other in the center of the nose to form the dorsum, hump or nasal bridge (misnamed by many people as the septum, which is not part of the nasal dorsum), creating what is called pyramid or bony or osseous or hard dorsum (cephalic or upper), formed by synostosis or fusion between bones, and the cartilaginous middle vault or soft pyramid or dorsum (caudal or lower), formed by synchondrosis or fusion between cartilages. In turn, the nasal dorsum is joined and merged by its lower or posterior face with the nasal septum, nasal septum which also, in turn, consists of a cephalic or upper bony part and a caudal or lower cartilaginous part, corresponding the bony septum to the fusion with the cephalic or upper or bony dorsum and the cartilaginous septum to the fusion with the caudal or lower or cartilaginous dorsum, forming a tripod in which the lateral legs are the nasal wall and the central leg the nasal septum.

In a canonically shaped nose the angle between the dorsum top or nasal profile line and the maxilla or nasal base line should lie within certain parameters, different depending on every particular facial balance; however in some people these two nasal lines are too convergent in an excessively narrow angle, which normally shapes a very high radix and a very low supratip, like a seesaw effect with the fulcrum at the middle dorsum and the heavier player sitting at the caudal or lower dorsum, whose might need very specific and customized supratip grafting to raise the caudal or lower nasal dorsum, supratip grafting according to the new angle planned and central dorsum sculpting to match a straight profile, frequently adding on its top and beneath the skin camouflage layers like perichondrium or temporalis fascia grafting, thus achieving a lesser width angle between nasal dorsum and maxilla; obviously the nasal tip might need projection increase to match the new dorsal angle.