Aesthetic Plastic Surgery

, Volume 43, Issue 5, pp 1257–1268 | Cite as

A Modified Dorsal Split Preservation Technique for Nasal Humps with Minor Bony Component: A Preliminary Report

  • Enrico Robotti
  • Nkhensani Yvonne Chauke-Malinga
  • Francesco Leone
Innovative Techniques Rhinoplasty



In scenarios of a dorsal hump with minor bony cap, ideal esthetic dorsal lines can be preserved and refined by component separation of the upper lateral cartilages from the septal T, resection of a septal strip and ethmoid bone wedge, adjustment of width and symmetry and final re-suture of the cartilaginous dorsum after pushdown, improving width and symmetry. The associated bony cap is managed by osteoplasty only with or without narrowing osteotomies, and septal deviations can be concomitantly corrected.


A novel technique of modified dorsal cartilaginous pushdown after component separation is described in detail. This method illustrates the importance of preserving the integrity of the septal T anatomy and the elastic keystone junction.


A preliminary series of 41 consecutive patients with follow-up up to 1 year, with a mean of 6 months, is reviewed.


All patients presented favorable outcomes with a natural looking dorsum. A learning curve led to progressive improvements by suture fixation of the septal T, finesse adjustment of dorsal width and symmetry, fine-tuning of deviation and gradual extension of the technique to include cases that required osteotomies without transverse element and those with any degree of septal manipulation.


Disrupting the keystone area is fraught with potential complications which often lead to secondary revision. A modified dorsal preservation technique with pushdown limited to the septal T component of the cartilaginous dorsum combines the popular component separation concept with the preservation of the delicate anatomy of the mid-vault.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Rhinoplasty Keystone Nasal dorsum Preservation rhinoplasty Pushdown Septal T 



The senior author acknowledges and thanks RK. Daniel, MD, for his support in the editing of this manuscript and his significant further contributions regarding pertaining anatomy and related nomenclature. We thank Leonardo Ioppolo, MD, for the 3D illustrations of the technique, shown within the accompanying video. We thank the patients whose photographs appear under study for their kind consent.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed were in accordance and with the 1964 Helsinki Declaration and its later approval amendments or comparable ethical standards. No study regarding ethical approval was performed.

Informed Consent

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

Supplementary material

Supplementary material 1 (WMV 43958 kb)

Supplementary material 2 (WMV 60127 kb)

Supplementary material 3 (WMV 50514 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  1. 1.BergamoItaly
  2. 2.JohannesburgSouth Africa
  3. 3.BergamoItaly

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