Filing Down the Dorsal Hump?
- Asked by Star05 in Neport Beach, CA, USA
- 5 years ago
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?
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.
Filing down a nasal hump in closed rhinoplasty
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.
Small nasal hump can be removed with a Closed Rhinoplasty
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.
Recent Rhinoplasty Reviews
Hump Removal via a Closed Rhinoplasty
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.
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
The leveling of a dorsal hump normally entails some filing of the bony portion of the hump and actual sharp excision of the cartilage portion of the hump. If that is the only problem with the nose then very likely no other procedures are required. If however, the removal of the hump leaves a flat surface of the nose which is more wide than desired, then it may be necessary to cut the nasal bones, moving them together and narrowing the dorsum of the nose.
Small hump on the Dorsum of the nose?
In the situation where you have just a small hump, a closed rhinoplasty to shave it down is in theory perfectly reasonable. The hump reduction may necessitate adjusting the width of you bridge to fit you face. WIthout seeing pictures of your nose it is difficult to say that you won’t need any other parts of the nose adjusted to compliment the hump reduction.
Generally speaking Closed Rhinoplasty should be used in patients who require less work. The advantage is a faster surgery, and faster recovery with less swelling. The disadvantage is reduced ability of the surgeon to manoeuvre instruments, and the loss of the direct line of site you get from an Open procedure. In the case of where a patient needs lots of spreader grafts or is undergoing a revision rhinoplasty, Open Rhinoplasty is the prefered method.
At the end of the day you should have your procedure done correctly, using whichever procedure your surgeon feels will comfortably get you the results you desire. Don’t compromise on your face.
Dorsal Hump in Closed Rhinoplasty
As you describe it, you have a very small hump on the top of your nose and this is your only concern. If that is the case, then closed rhinoplasty with shaving down the bump would provide an excellent result.
The main thing to be aware of is that it is very dependent on how "small" the hump is. The issue would be if after filing down the hump the rest of the nose appears to be too wide or if there is separation between the bones on the top of the nose. Usually when I offer a patient a closed rhinoplasty in this scenario I inform them of the possibility that I still may need to crack the nasal bones (osteotomy) in order to bring the bones together and prevent that gap, known as the "open roof".
Web reference: http://www.corygoldbergmd.com/closed-rhinoplasty.html
Filing Down the Dorsal Hump
Closed rhinoplasty or "endonasal rhinoplasty" is a great option for taking down a dorsal hump. As for osteotomies, it depends on the size and width of your hump. Many humps are large enough that their removal alone can cause a wide, flat spot. This is known as an "open roof" deformity. The osteotomies are done to medialize the nasal bones to close the roof (the tradeoffs are stepoffs alone where the nasal bones meet the cheek).
In certain cases, where the hump is small, it may not be necessary to perform osteotomies. If osteotomies are not performed, your recovery and bruising after the operating is usually not as bad.
Michael Kim, MD
Depends on the extent of the dorsal hump
A dorsal hump may require as little as shaving the bony hump down to as much as performing an osteotomy (breaking the bone) and shaving the cartilage down (often the bony hump extends into the junction with the septum). The extent of treatment requires an examination of your nose to determine the amount of bony and cartilaginous involvement. If there is indeed just a small bony hump then this can likely be fixed with rasping (filing) of the hump through a closed rhinoplasty approach and you would not need any further work on any other part of the nose. A larger hump may require removal of bone and cartilage as well as breaking the bones to narrow the bridge so that you do not have a widened nasal bridge from taking down the hump and your nasal breathing does not get affected.
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.