Routine reinsertion of the hump in rhinoplasty.

Reinsertion of the hump as a free graft, a technique based on the rhinoplasty described by Skoog, has been performed for more than 10 years in severely deviated noses to hide residual deformities of the septum after rhinoplasty. The results have been so encouraging that this technique is now routinely used in all rhinoplasties requiring a reduction of the profile. Grafting the hump after remodelling gives a natural aspect to the dorsum, especially in patients with thin skin where irregularities of sharp edges of the cut nasal bones are otherwise often seen. The hump is tailored into a thin composite graft (bone + cartilage) 3-4 cm long and 3-5 mm broad. No major complications have been observed. 32 cases have been reviewed after a mean delay of 24 months. 29 show radiographic evidence of bone graft survival although no fusion with the nasal bones is observed. It is suggested that facial bone grafts survive better in the nose than grafts taken from the iliac crest or the ribs.