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Filing Down the Dorsal Hump?

I have a small dorsal hump that I would like to get fixed on my nose, and was considering closed rhinoplasty. The plastic surgeon informed me that he could just go in and file it down without breaking or fracturing any bones. Does this sound like a good idea? The absolute only thing I want done is the hump shaved down, and it is very small. Will any other part of my nose need fixing if the surgeon simply files the hump down?

Doctor Answers (61)

Dorsal hump

+3

A small dorsal hump can be approached through a closed rhinoplasty technique. The dorsal hump can be addressed other by filing down the nasal bones for trimming the dorsal cartilage.  It the hump is very small and is largely due to excess dorsal  cartilage then nasal bone osteotomies may not be required.


Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

The dorsal hump and the dorsal aesthetic lines

+2
It is common for patients to have 1 or 2 things that really bother them about their nose. One of the most common concerns that prompts patients to seek rhinoplasty is the dorsal hump (bump). In many instances there are other aspects of the nose that could be improved simultaneously during rhinoplasty; some common problems include tip shape and position, crookedness, and poor nasal airflow. However, often times these problems are imperceptible to the patient presenting for rhinoplasty as they are focused on their major concern. Following surgery, these other problems may be more apparent to the patient once the major concern has been addressed. Additionally, reducing or reshaping the dorsal hump alone can cause a change in the relative proportions of the nose leading to an unbalanced look. Finally, reducing the dorsal hump without adequately addressing the nasal bones and transition point from the bones above to cartilages below can lead to several deformities and a suboptimal look. When widely situated bones are not osteotomized (broken) and moved in after the hump is taken down, problems including excessive width at the site of the dorsal hump on frontal view or an inverted-V deformity (upside down shadowing in the shape of a V on frontal view) may be created. The dorsal aesthetic lines can also appear flared and irregular in the area of the hump. The dorsal aesthetic lines are visible on frontal view and are the right and left light reflections that start at the medial aspects of the eyebrows, gently taper inward, proceed in straight down the right and left sides of the dorsum and then gently taper outward at the tip. Creating smooth and straight dorsal aesthetic lines should be a goal as well when reducing a dorsal hump as problems from the frontal view are very bothersome to patients since most of the time that we tend to see ourselves is straight on while looking in the mirror. Ill-defined or irregular dorsal aesthetic lines tends to be a common complaint from patients seeking revision rhinoplasty.

Jamil Ahmad, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 6 reviews

Filing down a nasal hump in closed rhinoplasty

+2

If the only issue with your nose is the hump, you can absolutely have this addressed with a closed, or endonasal rhinoplasty. In most cases, the hump is comprised of both bone and cartilage and some combination of shaving, filing, and chiseling the hump is utilized.

The important preoperative assessments for the surgeon are the size of the hump, the degree to which the patient wants to lower the bridge, and the length of the nasal bones.  If the patient does not desire a sgnificant bridge reduction ("finesse rhinoplasty") and the patient has adequate support in the middle vault, or bridge area, then simply filing/shaving down the hump may do the trick.

However, If the hump is larger and the nasal bones are on the shorter end, the upper lateral cartilages can lose support with time and the patient can develop an "inverted-V deformity". This can be avoided at the time of surgery with the placement of spreader grafts.

Lastly, if the humps is removed and there is an opening or flat area between the nasal bones (open roof deformity) then controlled fractures of the nasal bones (lateral osteotomies) may be performed at the time of surgery to close this roof and restore a normal appearance to the bridge. 

Regards,

Dr. Mehta

Umang Mehta, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 25 reviews

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Small nasal hump can be removed with a Closed Rhinoplasty

+2

If the nasal hump is small and consists only of extra nasal bone a simply filing with a closed rhinoplasty approach is sufficient. If the hump is larger or involves the upper lateral cartilages of the middle of the nose than simple removal may cause a flat spot called an open roof deformity. When this is the case the nasal bones nee to be brought closed together by infracturing the nasal bones to recreate the natural pyramid of the nose.

Andrew Jacono, MD
New York Facial Plastic Surgeon
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Hump Removal via a Closed Rhinoplasty

+2

Patients with a dorsal hump are ideal candidates for closed rhinoplasty. A dorsal hump is usually comprised of both bone and cartilage.

To remove a hump, an incision is made on the inside of the nose and a rasp is used to "file" the bony portion of the hump. If there is a cartilaginous component to the hump, this is trimmed with a scalpel.

One result of a hump removal is that it makes the bridge wider and may require osteotomies (breaking the nasal bones) to narrow the width of the bridge.

If your bridge is narrow, this may not be as much of a concern. However, if your bridge is currently a normal width or wide, hump removal with osteotomies may make your bridge even wider.

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
5.0 out of 5 stars 85 reviews

Closed Rhinoplasty

+2

If your only issue is a dorsal hump, a closed rhinoplasty can be a great way to treat the contour of the dorsum with rasping. Rhinoplasty surgery is very complicated and the balance, shape and integration of the structure of your nose with the rest of the face is a critical consideration when planning what you do and don't need. In my San Francisco area practice we spend significant time analyzing the face. Make sure that your plastic surgeon spends considerable time discussing things like the projection of your nose, the angle of the tip, the shape of the tip of your nose, the shape and contour of your nostrils, the balance of your nose in comparison to the shape and projection of your chin, etc. (the list of things to review is actually quite extensive). If at that point your surgeon and you agree that it is only the dorsal hump should be addressed then a closed rhinoplasty is an effective way to treat this.

I hope this helps.

Steven Williams, MD

Steven H. Williams, MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 21 reviews

Reducing a nasal hump without rebreaking the nose.

+1
In my experience, it is the relatively rare exception rather than the rule that a dorsal hump on the nose can be removed without the need to fracture the nose. This is because most of these bumps or humps are a combination of bone and cartilage. If you take down the bony component without fracturing the nose, the dorsum or bridge can look unnaturally squared off as the bones do not angle in on their own without fracturing.  Careful inspection on the nose is paramount in making the proper treatment plan.

Arthur N. Falk, MD
Albany Facial Plastic Surgeon
4.5 out of 5 stars 7 reviews

Filing the hump down only

+1
If the hump is small, filing it down on its own is reasonable though without seeing your pictures this is difficult to tell.  In general, 9 out of 10 times, osteotomies, or breaking of the nose, is required.  There are occasional cases where the hump is subtle and a mild rasping of the bone is all that is needed without addressing the width of the nasal bridge or closing an 'open roof' created by the rasping.  

Mike Majmundar, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 22 reviews

Filing Down the Dorsal Hump?

+1
A dorsal hump is a common appearance of the nose that can be improved with rhinoplasty. The bump usually is combination of both cartilage and bones that can be shaped and modelled to give an improved nasal profile. Both open and closed techniques can be used to reduce a dorsal hump.
Other considerations are also important including the width of the nose and need to bring the bones inwards after reducing the bump (termed osteotomies). Depending on the size of the hump different procedures may be required to give the best aesthetic result. A further consideration is the need to maintain functional breathing when reducing the size of the nose (including the use of cartilage grafts and septoplasty).
Different surgeons may reduce a nasal bump by a variety of different techniques including conventional rasps to more innovations burrs and micro-tool devices that may offer more control and reduced swelling.

Julian De Silva, MD
London Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

Filing down a dorsal hump

+1
 Filing down a small dorsal hump can be accomplished without osteotomies as long as the hump is small and an open roof deformity is not created by the filing technique. If an open roof deformity  is present, then osteotomies will be required to close it. In the majority of cases osteotomies are required when performing a rhinoplasty.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 54 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.