Some patients have a prominent dorsal hump due to a large nasal septum and this result in a tension nose.  Here, the nose often has a narrow appearance from the frontal view.  Reduction of the dorsal hump and use of spreader grafts can result in a more balanced view.

Many patients have a narrow nose on frontal view but with a prominent dorsal hump.  This is often described as a tension nose.  In these instances reduction of the dorsal hump does not require fracturing of the nose as the newly widened appearance is desired.  Ideally the width of then nose should equate to one fifth of the width of the whole face or equal to the width of the eye.  A patient who has had too much tissue removed in the form of an alar wedge resection may require a revision procedure to widen this.  This can be achieved by using a composite graft of a piece of cartilage and skin from the ear and inserted into the nostril to give it a wider appearance.  Please see before and after examples.