Rhinoplasty on a wide nose with a V-shaped dorsum: before and after

Comment by Dr. Gustavo Sordo

Reason for consultation

She had a prominent dorsal hump, not very large, and wanted her nose to be more defined and narrower. She also had difficulty breathing.

What I observed when evaluating it

A wide nose with a V-shaped bridge, set on mixed skin, and a septum deviated to the right, which explained the breathing difficulty. The bridge of the nose was not large, allowing for very precise work. And the nasolabial angle was already correct, at about 120°.

What was important to preserve

The nasolabial angle. It was already correct, so the goal was not to modify it, but to work on the dorsum and width without altering that balance of the tip.

My surgical approach

Narrow and define the nose in its two widths, that of the dorsum and that of the base; correct the deviation of the septum so that he could breathe better, and support the tip without changing its angle.

Why I chose this technique

With small humps, ultrasonic rhinoplasty allows for the removal of precisely what is needed without overdoing it. In a V-shaped dorsum, spreader grafts reconstruct the bridge after reducing the hump, leaving it narrow and well-defined. The septal extension graft gives the tip firm support, allowing for adjustment without changing its angle. And the alototomy narrows the base of the nose, something that cannot be achieved by working on the bridge alone.

What I did during surgery

I reduced the bridge of the nose using ultrasonic instrumentation and reconstructed the dorsum with spacer grafts to narrow and define it. I corrected the deviated septum and addressed the turbinates in the same surgery. I adjusted the tip over a septal extension graft, respecting the nasolabial angle, and performed an allotomy to narrow the base, with the incision right at the junction of the wing and the face, which is where, in my experience, the scar is least visible. General anesthesia (TIVA) was used; the procedure lasted approximately three hours, and I stayed overnight in the hospital.

What is observed in the result

At 15 months, the nose is narrower and better defined, both on the bridge and at the base, with the same tip angle it had from the start. And it breathes better.

More cases of wide noses in this collection; the technique and the rest of the cases are on the rhinoplasty page in Madrid. Why a V-shaped dorsum is operated on differently than an S-shaped one is explained in the V-shaped dorsums and S-shaped dorsums sections.