I have a bump on the profile that I would like have gone, but am curious as to if there are any other less traumatizing ways to get rid of a bump other than shaving it. My face is long, and I'm not sure how my nose will look if the bump goes away; does shaving the bump make the nose shorter/smaller? Also I understand that sometimes the bridge appears wider in the front when the bump gets taken away. Is there any way a PS can use a graft and make my nose even? I do want minor tip work as well.
Adding to my Nose Instead of Taking Away? (photo)
Doctor Answers (10)
Nasal grafting in rhinoplasty instead of reducing
You are absolutely correct. Kudos to you for having the aesthetic insight! You have very little tip projection and an acute nasolabial angle. You would certainly be better served with a columellar strut for tip support and to open your nasolabial angle. You will likely need a small tip graft as well if tip suturing does not create sufficient definition. These maneuvers would nearly completely hide your dorsal bump. supraseptal spreader grafts would complete the rhinoplasty by refining the dorsum and likely improving your breathing. Simply taking down the hump and infracturing may lead to a result that you would find acceptable but is certainly not ideal for your face. I hope this helps!
All the best,
Rian A. Maercks M.D.
Addressing nasal hump without removing it
When there is a shallow nasal root or glabellar area, grafting techniques may be performed to give more height to the glabella. Tip work is performed to feminize and refine the nasal tip. When both glabella and tip work are performed, the midportion of the nose and the bump on the bridge will need to be addressed, probably through filing the bridge line down. It is impossible to do just tip work and just a graft in the glabella without doing some work in between in the mid bridge line so that the entire nose is balanced with itself and your facial features.
You do have the option of a non-surgical rhinoplasty to add to the radix (top of nose) - making the bump less apparent
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Combining both tip augmentation and dorsal reduction to achieve the ideal tip and profile.
When deciding how to best improve the nasal profile it is imperative to simultaneously consider what the aesthetic goals for the nasal tip are. Essential to achieving the best cosmetic outcome is an accurate preoperative analysis and plan. Each case will require its individualized surgical plan. In some cases it may be necessary to only remove bone and cartilage in the middle third. In other cases it may be necessary to increase tip and supratip projection. Finally some patients would be best served using both strategies.
In your situation, I agree that your nasal tip is under projected, down-rotated and inadequately defined. The profile shows a mild dorsal hump. Based on just your photos my recommendation would be conservative hump reduction in the middle vault combined with volume reduction, columellar cartilage strut grafting and suture techniques to up-rotate and increase tip definition and projection. Tip grafting may be necessary but bear in mind these need to be carefully carved to prevent graft edge visibility down the road. A tip graft may not be advisable if you have thin skin.
Finally, your questions regarding the impact of dorsum reduction and tip position on overall nasal length and width are very pertinent. Reduction of the nasal dorsum will not impact tip length unless the reduction extends into the nasal radix (the region just above and below junction between the forehead and the nose know as the nasion). Bone removal in the radix will decrease nasal length. Up-rotating the nasal tip will also decrease nasal length. The impact of both of these maneuvers on nasal length need to be carefully considered during surgical planning. In your situation, reduction of the nasal dorsum should not reach into the radix, however, up-rotating the nasal tip will shorten your nose to a certain degree and you may wish to limit the degree of up-rotation based on the overall proportions between your nose and your total facial height. Dorsum reduction will have the tendency to increase the width across the nasal bridge. However, this can be minimized by in-fracturing the sidewalls of the nose.
I applaud your approach in wanting to understand the details of rhinoplasty before surgery. I find patients such as you the easiest to deal with in the long run.
Good Luck. Mario J. Imola, MD, DDS, FRCSC.
In your posted photo the bump looks like it is more cartilage than it is bone. The options then are to cut back some of the cartilage, put a graft above the bump to mask it or some combination of the two. If the bump is removed leaving an open roof and the nasal bone sidewalls are not moved inward the bridge can look wider. I would think your best options are remove the hump, nasal bone infracture and trim the upper edge of the tip cartilages.
I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.
Bump on nose
More than likely you will need the bone shaved to remove the bump. An exam would be necessary to assess this properly.
Dermal fillers such as Juvederm or Radiesse are great injections for the nose to augment the dorsum.
Options to correct nasal bump and refine nose.
Your morphed photos show a nasal profile which could be accomplished with a small cartilage graft placed just above your nasal bump. This graft would fill in the small depression and thus make the bump look like it is gone without removing it. Tip work, usually done by suturing techniques could be done at the same time to refine your nasal tip. This would give you a subtle change to your nose, so it would still be in harmony with the rest of your face.
Nasal Grafting in Rhinoplasty
Rhinoplasty is by far the most artistic and technically demanding procedure in facial plastic surgery. I believe that the goal of rhinoplasty should be a nose that looks and feels natural and is in harmony with the rest of the face without having an "operated upon" appearance. I often use nasal grafting in cases such as yours to achieve this harmony. You are an excellent candidate for this procedure. Be sure to consult with an experienced Facial Plastic Surgeon to assure the results you are wanting. Best of Luck!
Rhinoplasty for the wide nose with a bulbous tip and hump.
Rhinoplasty for the wide nose with a bulbous tip and hump can be done to give you what you have shown. Your tip needs to be projected slightly as you have done and the bones narrowed. See an experienced rhinoplasty surgeon for the best results.
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.