Fig. 6 – 3. Do not overtake the hump. At the beginning of the procedure, reduce the hump subtotally, then more reduction if needed is made at the end of the procedure after tip correction.
Fig. 6 – 4. The scissors is passed through all the three components of the cartilagenous hump, Leave the superior septal angle intact until the end of the procedure.
- Causes of “pollybeak” deformity. 1. Excess supratip cartilage. 2. Poor tip elevation and rotation. 3. Injury to the SMAS layer of the supratip skin will lead to delayed scarring and fibrosis later. 4. Oversize supratip graft.
- Visualize the dorsum at the end of hump removal, make sure all cut lines are straight, remove all residual bone dust and debris by gently rasping under the surface of the skin with a fine rasp. If dust and debris remain, this might cause an early infection or an unexplained hump or irregularity later.
- Large hump and crooked nose: T-shape twelve mm osteotome is used. The osteotome is not positioned parallel to the face but in a slightly oblique position away from the deviated side in order to achieve and leave equal nasal bony lateral walls and to avoid overlapping of the bones after approximation. Imagine the nose as a triangle with unequal sides; in order to leave two equal borders, you have to cut obliquely. (Fig. 9 – 12)
- For smaller hump: In the author’s opinion, it is best to leave it alone and try to achieve balance by achieving more tip projection, elevation and definition. Rasping alone without the use of hump osteotome may lead later to irregularity and persistent hump due to fibrosis and scarring. At the same time, osteotome may overtake the smaller hump leading to further augmentation with the problems related to grafting such as graft absorption, mobility, displacement and line of demarcation later on.
|Fig. 6 – 5. The bony hump is removed on the conjunction with the cartilagenous component with an osteotome|
|Fig. 6 – 7. The dorsum after hump removal. Now, osteotomies are needed to close the open roof by approximating the nasal bones and upper lateral cartilages.|
Fig. 6 – 8. The hump has been reduced with tip plasty also been considered in order to achieve a straight nose and tip projection.