Nasal middle vault support: a new technique.

A novel technique for maintaining internal nasal valve anatomic and physiologic integrity at the time of hump reduction is proposed. The procedure involves mobilizing the anterior edge of the upper lateral cartilage after submucosal dissection. Reduction of the anterior border of the septal cartilage and reconstruction of the middle vault of the nose is accomplished by placing the upper lateral cartilage medial border on the reduced edge of the septum using a vest-over technique. The technique was successfully used for 32 nonconsecutive patients over a 4-year period.