Shaping the nasal dorsum

Shaping a proper dorsum must constitute an essential part of rhinoplasty. This article addresses the main current concepts that play a significant role in dorsal modifications: proper exposure at the keystone, component separation and incremental reduction, straightening the septum and positioning it in the midline, mobilizing and reshaping the nasal bones by osteotomies and osteoplasties, and finally reconstituting a barrel vault of appropriate width and proper contour. The importance of power tools and piezoelectric instrumentation is highlighted, as well as the relevance of simulation and computed tomography (CT) imaging as key to bone and septal work. Finally, the key principles of rebuilding the dorsum in revision rhinoplasty are detailed.