Ask a doctor

How Does a Dorsal Hump Usually Reduced?

I've been considering getting a Rhinoplasty to fix the hump on my nose, but I was wondering, what exactly does the surgeon do to correct this? I've been looking up on dorsal hump reductions and I am not quite sure what open and closed Rhinoplasty's are, as well as the term "breaking the bones." What I want to know is: what would the surgeon do to correct this. I have included my photo for your reference.

Doctor Answers (13)

Rhinoplasty for Removal of a Dorsal Hump

+2

The appearance of a dorsal hump (hump on bridge of the nose) is created by the interplay of several factors: the contour (profile) of the bridge, amount of tip projection, and the depth of the radix (deepest portion of the nose between the nose.

The bridge profile contributes most to the appearance of a dorsal hump. The bridge - and most dorsal humps - is made up of cartilage (lower half) and bone (upper half). Thus, to correct a dorsal hump, the cartilage and bone must be lowered to the proper level. The cartilage can be shaved or trimmed, but the bone must be filed down (rasped). Once a hump is removed, it can leave a gap in the bones along the top of the bridge. This gap is called an open roof deformity and is usually closed by "breaking" the nasal bones and moving them inwards. This is referred to as nasal bone osteotomies. With osteotomies, the bones are actually cut with a delicate chisel and which allows them to be repositioned, narrowed, or made symmetrical in the case of a deviated (crooked) nose.

Other factors such as the amount of tip projection and depth of the radix can contribute to the appearance of a hump. The tip should extend anteriorly slightly more than the bridge profile. If a patient has a deep radix, the dorsal hump may be exaggerated. Filling in the radix with a cartilage or soft tissue graft can help.

Dallas Facial Plastic Surgeon
5.0 out of 5 stars 81 reviews

Hump would be removed and nasal bones narrowed

+1

The hump of the nose is composed of bone on top and cartilage in the mid portion of the nose. The tip can also contribute to a portion of the lower third of the nose. The hump is removed with scissors and knife, sculpted to a normal anatomical position, and filed smooth. Then osteotomies are made in the nasal bones, and the nasal bones are narrowed to close the open roof, which is created by removing a large hump. If the nasal bones are not narrowed, then open roof and flat top deformity will occur as a direct result of only a hump removal.

Seattle Facial Plastic Surgeon
5.0 out of 5 stars 52 reviews

Dorsal hump reduction rhinoplasty

+1

Thanks for the picture! This is a great reference to help you with your question. Hump reduction in rhinoplasty, especially in your case, it not as simple as it seems. Think of the top portion of the nose as being a pyramid, with the hump being at the top. If you go in and simply shave off the top of the pyramid, you will be left with something called and open roof deformity. This will make the nose look flat. In order to prevent this, the roof needs to be closed. This requires surgically "breaking" the bones so that they come together at the top. The remainer of the surgery involves contouring the cartilages at the tip of the nose in order to provide symmetry and balance.

Hope this helps! Let us know if you have other questions.

Annapolis Facial Plastic Surgeon
5.0 out of 5 stars 4 reviews

Dorsal hump reduction is done through bone and cartilage reduction

+1

Hi, rhinoplasty is a complex surgery, but hopefully this will help. The hump on the top of your nose is made of both cartilage and bone. During surgery, the cartilage is usually reduced with a knife, and the bone is reduced by filing or actually cutting it with a chisel-like instrument. After this is done, the bones are very commonly broken on the sides to reduce the width of the nose and close the defect left by reducing that dorsal hump. This is called an osteotomy. An open rhinoplasty means that an incision is made at the base of the nose to expose the tissues, and a closed rhinoplasty means that all of the incisions are inside the nose. Every surgeon has his or her own preference about which technique to use. Based on your photos, you would need to have the dorsal hump reduced and the bones broken. I suspect that you would also need a few other refinements, but it's difficult to say exactly based only on the above photograph. I hope this helps. Good luck!

New York Plastic Surgeon
4.0 out of 5 stars 5 reviews

My 2 cents

+1

You will need to have the hump rasped or filed down. In addition, you have what appears to be a low "take off", meaning that the nose is low at the forehead end. I would guess that you will need a cartilage graft.

Breaking the bones (aka, osteotomy) is done with a mallet and surgical chisel, under controlled conditions.

Hope this helps.

sek

Dallas Plastic Surgeon
4.5 out of 5 stars 44 reviews

Rhinoplasty is a complex surgery

+1

Rhinoplasty is a complex surgery and trying to isolate just one component (hump reduction) is difficult without knowing all of the involved dynamics and anatomy. However, your surgery can be performed either open (making an incision on your columella) or closed (making the incisions only inside your nose). A rasp and/or chisel instrument is then used to remove the hump. However, hump reduction it is often necessary to break the bones and push them together to fill in the open area where the hump was removed. I hope this is helpful. Good luck with your surgery.

New York Plastic Surgeon
5.0 out of 5 stars 52 reviews

Reduction of a hump is a common part of rhinoplasty

+1

The most common request in nasal shaping or rhinoplasty is removing the appearance of the hump on the nose. Patients with a strong nasal hump often exhibit the most dramatic improvement after rhinoplasty and websites are filled with examples.

The hump or bridge of the nose is comprised if a short bony part, and a larger part which is cartilage. There are many techniques to shape and cut the cartilage and the bone to fit the goal of surgery. We don't like to think of these cuts as breaking the nose as these are done in a precise and controlled way. The cuts do soften the support of the nose and therefore a splint is needed followed by three weeks of healing to protect the nose after surgery.

From a single picture it is not possible to say exactly whether or how the bridge of your nose should be changed. It is best to consider the whole nose as the bridge and tip should be kept in proportion to one another. There is nothing simple, or hard in rhinoplasty for that matter. The results will depend on your nasal and facial shape, and the aesthetic goals you decide on with your surgeon. Much of the controversy can be about what looks "right". We suggest computer imaging to help both you and your surgeon understand what is best for you.

Best of luck,

peterejohnsonmd

Web reference: http://www.peterejohnsonmd.com/rhinoplasty

Chicago Plastic Surgeon
4.0 out of 5 stars 25 reviews

Bump is addressed with Cartilage and bone reduction

+1

Agree that your nasal tip is weakly projected which makes the bridge appear more prominent.  Methods to improve this must address increasing your tip projection.  The bump is usually dealt with by rasping or partially cutting through the bone or cartliage.

Youngstown Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

The nasal hump is actually not your main problem.

+1

Hi!

You have two other problems that make the hump look much larger than it really is.

1) The bone up on your nose between your eyes (called the nasion) is quite low.

2) The tip of your nose is quite low and does not stick up from your face (you lack "tip projection").

If these two areas are raised with cartilage grafts, your "hump" would practically go away, and it would need MINIMAL lowering to give you a straight profile. If the two other areas are not corrected, then the hump would have to be lowered too much and you would have a flat profile.

So you need a sophisticated open rhinoplasty with cartilage grafts. In NYC, we take the cartilage grafts from inside the nose. To answer your original question, the actual lowering of the hump is easy and is done with a rasp.

Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Nose Job: how do you remove the hump???

+1

There are many options when it comes to rhinoplasty and surgeons have many differing opinions as to how this is best accomplished:

  1. Some remove it in one piece
  2. Some remove it in two pieces (cartilage and bone)
  3. Some use a manual saw
  4. Some us a power saw
  5. Some use a rasp
  6. Some use a power rasp
  7. Some use a power burr
  8. Some remove it, modify it and put it back as a smaller piece
  9. Some remove it, leaving an opening that is closed by bringing the side walls together
  10. Some place a graft to smooth and act as a veneer.

As you can see there are many options and your surgeon may have their own technique.

It appears from your picture that although you have a prominent hump, you also have a deficient bridge. Your best result may come from a combination of taking down the hump and building up the bridge.

Chicago Plastic Surgeon
5.0 out of 5 stars 39 reviews

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.