In this young man, the dorsal hump is immediately noticeable, accentuated by the deficiency at the radix and the limited structural support of the tip. As mentioned in other cases, if only the hump reduction were performed, the tip would collapse even further downward because it would lose the relative element of “compensation” that helps support it—the hump itself. In addition to the inadequate tip projection, the depression at the radix must also be noted. Once again, this leads back to the fundamental concept of proportions in rhinoplasty, achievable through a carefully balanced combination of reduction (of excessive components) and augmentation with grafts (to restore deficient areas).

In the frontal view, the deviation is clearly evident, and it is associated with an even more significant deviation of the nasal septum. CT imaging is the gold standard for identifying this and other nasal issues. A single clinical exam, although capable of detecting the presence of the deviation, would not have revealed its true extent, and even a simple X-ray would have been insufficient. Overlooking this septal deformity would result in a worsening of the patient’s already suboptimal breathing after osteotomies and the consequent reduction of the intranasal airway volume.

Additionally, this patient’s skin is particularly thin, requiring a temporalis fascia graft both to raise the radix and to achieve a smooth and uniform dorsum.