Controlling the Nasal Dorsum
Controlling the nasal dorsum is vital and done along with the tip work and can be challenging to establish an aesthetic and pleasing dorsal profile line. Either augmentation or reduction may be needed to establish the profile "in line" with the nasal tip projection. Moving the bony complex either to correct the side deviation or to narrow the roof or to narrow the nasal base requires osteotomies both lateral and medial. In our experience, bony dorsal work involving osteotomies can be the most challenging part of a rhinoplasty since it is not easy to correct and stabilise a bony complex exactly in the midline. Most of our revision surgeries are due to osteotomy failures and not due to soft tissues failures involving the tip cartilages. Osteotomies are the most difficult procedures to understand and master.