The shape of the nose is as varied amongst people as the weather is on any one day around the world. While not quite as distinct as a fingerprint, one’s nose shape is fairly unique in each individual. But despite this tremendous diversity in appearance, there are certain nasal shapes that many patients strive to achieve regardless of what their natural nose looks like. This creates a real challenge for any rhinoplasty surgeon in trying to achieve patient expectations.
But one aspect of nasal shape that is the least controversial and can be argued to be the most straightforward to change is the of the dorsal line. Viewed primarily in the side view the dorsal line of the nose is the profile shape from the top of the nose down to the tip along the skin. It can only have have three different profiles, straight, convex or concave. While the dorsal line does have aesthetic considerations in the front view, these do not have quite the significance as how it appears in the profile and oblique facial views.
The dorsal line is affected by the height of the nasal bones and the septum and can appear convex with a hump or concave with a saddle nose. In general a straight dorsal line is the safest aesthetic shape and would be considered one primary goal in many rhinoplasty surgeries. It is also considered the functionally safest nasal shape as it prevents collapse of the middle vault and potential nasal airway insufficiency.
The dorsal line is also considered gender neutral, being that a straight-line shape is desired by both men and women. But this is not always the case. In some women who seek a ‘cuter’ or definitely a strong feminine nose, a more concave dorsal line profile is preferred. It is the antithesis for treating a larger dorsal hump or a hook nose. Changing the dorsal line to this profile is particularly useful in transgender male to female rhinoplasty where ‘overdoing’ the dorsal line reduction helps create a more feminine appearance. As it turns out I have yet to have a male who wants anything other than a straight dorsal line and some may even prefer the maintenance of a residual dorsal hump or convexity.
In the older female nose where some tip dropping may have occurred, rotating the tip upward and lowering the dorsal line, can have a rejuvenating facial effect.
Determine before surgery what type of dorsal line profile a patients wants is one of the most straightforward imaging changes to make. Its impact affects the entire rhinoplasty result and is usually one of the top three types of changes a patient wants to surgically make to their nose.
Dr. Barry Eppley
Indianapolis, Indiana