Irregular 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.

Bridge hump shaving is a controlled and precision maneuver with cartilage resection with scalpel, osteotomy with bone chisel and rasping with a surgical rasp for fine regularization; it is a a basic and essential maneuver in the vast majority of rhinoplasties, being the refinement in its execution a critical element for achieving outstanding results after rhinoplasty, prevention of complication and absence of well known and typical postoperative deformities, being one of them an irregular, lumpy, asymmetrical dorsum with random ridges and little bumps; even in the best hands exuberant osseous, cartilaginous or merely fibrotic callus may develop overgrowth and lead to a localized bump at the dorsum as well.

Those noses with very thin dermis of nasal skin cover, scarce subcutaneous fat, already somehow transparent and showing internal natural skeletal structures through the skin, particularly at the nasal dorsum and the nasal tip, are prone to let the technical issues of rhinoplasties be externally visible with great ease and therefore aggravating their irregularities.

As prevention or once the irregularities have been produced it might be indicated adding on their top and beneath the skin camouflage layers like perichondrium or temporalis fascia grafting.

Dorsum irregularities require revision to redo the hump work with better planning and skills o to simply shave down an unavoidable dorsum callus.