BACKGROUND: Hump reduction in aesthetic rhinoplasty destabilizes the middle vault. Secondary maneuvers are necessary to avoid the long-term functional and aesthetic sequelae of middle vault collapse. We describe a new technique of reinserting the resected hump that combines (a) placement of the modified hump between the upper laterals and (b) bridging sutures between the upper laterals.METHODS: Retrospective review of patients undergoing primary aesthetic rhinoplasty with hump resection.RESULTS: Sixty-two patients, 46 with a straight and 16 with a deviated nose, enrolled. Twenty-three patients were operated through an open approach and 39 through a closed approach. Osteotomies were necessary in 56 patients. Mean follow-up was 13 months (range, 9-16 mo). A satisfactory result was achieved in all but 3 patients who had visible irregularities. Two of them required minimal rasping under local anesthesia and the third patient refused any further treatment.CONCLUSIONS: Our modification of Skoog's original technique has certain advantages: the hump acts as a spreader and onlay graft, which preserves the natural dorsal lines. The sutures increase the nasal valve angle while preventing displacement of the reinserted hump. Indications include a straight or mildly deviated nose, a long thin-skinned nose with short nasal bones. The technique is also feasible through the closed or open approach and offers a valuable alternative to spreader grafts or flaps.