ACCURATE recontouring and restoration of a normal nasal dorsum is difficult to achieve after total removal of the hump according to the method originally described by Joseph.1 Apart from minor differences in surgical techniques, using osteotomes, saws, or special forceps, Joseph's principle of discarding the specific anatomical structures of the dorsal nasal framework is, however, still widely accepted and the only one recommended in current textbooks on the subject. The well-known pitfalls of this method are excessive removal of the nasal framework and asymmetrical reduction due to miscalculation or imperfect technique. These unfortunate sequelae may occur even in the most experienced hands, and, once made, they require extensive surgery for correction. Another great disadvantage of present techniques is that all too frequently the sharp edges of the nasal bones or the septum project, marring the operative result. Surgically, the accurate elimination of minor irregularities of the cut edges of
SKOOG T. A Method of Hump Reduction in Rhinoplasty: A Technique for Preservation of the Nasal Roof. Arch Otolaryngol. 1966;83(3):283–287. doi:10.1001/archotol.1966.00760020285020
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