I want to remove a large dorsal hump, deproject the nose slightly and remove a hanging columella. Is it possible to change the shape of my dorsal hump so it is dead straight (maybe have a slight convex curve) with no bump or supra tip break? When i asked a surgeon he said its not possible to make it straight but will have to have a bump near the bridge and a slight 'break' lower down near the tip. Was he right? Also does raising the tip by raising columella prevent the dorsal hump straight?
Achieving Straight Dorsal Hump?
Doctor Answers 10
Straight nasal profile is possible with rhinoplasty
It is certainly okay to perform a conservative rhinoplasty and leave a small hump present. However, it is best to find a surgeon who has performed many rhinoplasties and make sure there is good communication between the patient and the surgeon. In addition, computer imaging done at the consult would help to express exactly what the patient wants. It is possible to give a straight profile without a convexity or concavity and the columella can be trimmed back to give the effect of shortening the nose.
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Straight Dorsum with Rhinoplasty Surgery
John, in my opinion it is definitely possible to achieve what you are envisioning. Changing the columella and tip can be done independently of keeping the dorsum straight. Here is a link below to one of my online chapters that focuses on management of the dorsal hump deformity. Wishing you the best of luck!
I want a straight dorsum
It is difficult to give you a recommendation for your nose without a consultation and good photographs. Men typically desire a strong dorsum, even with some convexity. It should be possible to acheive this for you. The issue of a "hanging columella indicates to me that you may have poor columella support there and this and your tip will need some work. This will not address the issue of the dorsum though. The concept of a balanced nose comes to play here, that one change in a part of the nose affects another part and hence the overall shape. Each component should be addressed to provide the most symmetric result within the context of the face.
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Straight Dorsal Line FRom Rhinoplasty
There should be no reason why you shouldn't have as the objective a straight dorsal line if that is what you want. If the nasal bones were only going to be rasped, then a straight line is not achievable. But if the hump is more significantly reduced and osteotomies are used to close the resultant open roof, getting a straight dorsal line should be possible...or at least close as possible. With good dorsal line reduction, elevating the tip is more likely to result in a supratip break. For this reason how much of the top of the caudal end of the septum that is removed must be carefully done to avoid creating that effect.
Creating a straight profile with hump reduction
It is possible to create a straight profile with hump removal if you prefer that look. It sounds like you're looking to maintain a more masculine appearance which is very common among male patients.
You should be able to have your tip projection reduced and hanging columella addressed at the same tip.
Check out my web reference link below to learn more.
Can I have the nose shape that i want?
Yes, the slope of the bridge of your nose can be adjusted to any level.
The bridge can be left slightly full, dead straight, or slightly lower than the tip with a "supra-tip break" (tip projecting slightly beyond the slope).
Generally, the bridge of the nose, or "slope", should be slightly lower than the tip projection for optimal aesthetics. However, for men, this can be feminizing if done too low, and needs to be carefully discussed before surgery.
There are two major pitfalls to avoid when doing male facial surgery - they are with the upper eyelids and the nose. Overdoing the skin removal of men's upper eyelids is extremely feminizing, as can be seen in some popular celebrities who have had this happen to them. Then other is overdoing the bridge reduction in rhinoplasty.
Be sure the surgeon you choose has these sensibilities in mind when planning your surgery.
Best of luck,
Dr. Gregory Diehl
Rhinoplasty, nose surgery
Addressing dorsal humps, small, medium or large ones are the most common steps in rhinoplasties. Feminine noses , they have gentle concave dorsum with tips being the most projectile part of the nose. masculine noses, usually have staight dorsum or with a very minimal concavities. An experienced plastic surgeon can reshape the dorsum od the nose accordingly, by reducing the bony part , cartilaginous portion of the dorsum or both by open or closed rhinoplasty. In order to have aesthetically acceptable results the tip of the nose should remain the most projectal part of a nose in women or men.
a straight nose both in the frontal (portrait) and profile view is a common goal of most rhinopasties. it seems as if your question relates to the profile view. if i understand you question you seem to want to have a straight line from the the nasio (take off point between the eyes) and the tip. (ie no hump no suprtip break). this is the desired configuration for a man, while in a women one would aim for a slight supratip break). you posted with the name johnl so i assume you are a man. so your staighted desire for nasal shape matches your gender and your expectations are likely reasonable. and yes i do think think a surgeon should generally be able to tell you that is the goal of the surgery - baring any unusual anatomy, it should be a reasonable goal. with that said, a male nose will tolerate a slight supratip break. so the goal should be slight break or no break. this is important, because if one ends up with and underprojected tip in an effort to prevent any break at all that creates a look that is universally unattractive.
Types of nasal profile possible with rhinoplasty.
During rhinoplasty, careful planning and technique can result in either a convex, straight or concave profile. A supratip break is commonly used when the goal is a gently concave profile. Working on the columella should not affect the dorsum.
Mario J. imola, MD, DDS, FRCSC.
Straight Dorsal Profile after Rhinoplasty
I respectfully disagree with your surgeon and feel that a patient can have a straight profile without a supra-tip break after hump removal. Maybe you misunderstood because this is something I frequently do. Raising a hanging columella will have no effect on your hump.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.