I would like it filed down slightly and would like to avoid an osteotomy. I am fine with other aspects of my nose and am not looking for a dramatic change. I just want it filed down so that I have a more attractive nose. Based on the photo I have included does this seem like a reasonable request?
Fixing the Dorsal Hump on my Nose Without an Osteotomy
Doctor Answers (24)
Nose hump reduction often needs bone repositioning - this is safe and time-tested for rhinoplasty
Hump reduction without osteotomies is like having an offense without a defense - the two go hand-in-hand. Doing the hump reduction alone will cause the dreaded "open roof" deformity, a problem you don't want to have. To defend against this, osteotomies (controlled breakage of the nasal bones) and "infracturing" (repositioning the bones inward) prevents the open roof from happening. Sure, with thick skin, a tiny hump can be improved without osteotomies, or volumizing the bridge of the nose with filler (the so-called "liquid nose job") works well to hide small humps. However, with a moderate to large hump (I'd say yours is moderate in size), osteotomies will keep the open roof problem at bay. And, although breaking bones sounds barbaric, it actually doesn't take that much force to do (the bones are very thin), and you will not have significant discomfort after surgery. It's a tried-and-true technique that works extremely well and is a normal part of rhinoplasty surgery. If I told you that I want to stab a sharp instrument through your ear to make a hole, you might think twice about getting your ears pierced. My point is not to fear "osteotomies" because of what you may have heard. Instead, put yourself in the hands of a board certified plastic surgeon who does good rhinoplasty work and communicate about your needs.
Removing dorsal hump without an osteotomy
Sometimes it is possible to reduce a small dorsal hump without performing an osteotomy. Determining factors include the size of the hump, the amount you would like it reduced, and the thickness of you nasal bones. From your photo that you submitted, I would think it would be quite unlikely that a satisfactory result could be obtained without an osteotomy. You should listen to your surgeon and go ahead with what he or she suggests in order to get the best result.
Dorsal hump - no osteotomies
It would help to see a front view but in some cases where the nasal walls are very vertical, it is possible to take down a dorsal hump without osteotomies. In fact, I just did this on a patient last week and she had a beautiful result! However, you will have to be more conservative with how much of the hump is taken down.
I would recommend you seek consultation with an experienced rhinoplasty surgeon to discuss what your options are and openly discuss your desire to avoid osteotomies. They will be able to determine whether this is possible with your anatomy.
Dr. Cat Begovic M.D.
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Can a Nose Hump be smoothed WITHOUT Breaking the Cheek / Nose Bones
Regarding: "Fixing the Dorsal Hump on my Nose Without an Osteotomy - I would like it filed down slightly and would like to avoid an osteotomy. I am fine with other aspects of my nose and am not looking for a dramatic change. I just want it filed down so that I have a more attractive nose. Based on the photo I have included does this seem like a reasonable request?"
Minor dorsal nose humps can be reduced without having the break the nasal bones and narrow the top. But - with larger humps, such as the one you have which contains a large cartilaginous component and a nasal bone component, reducing the hump without fracturing and moving the bones in would surely result in a very ugly and wide open roof deformity. You could have a great looking nose but there is no way around doing osteotomies in my opinion.
Dr. Peter Aldea
Removing dorsal humps often require osteotomies
When taking significant humps off of a nose, a flat top nose or an open roof deformity will result. Osteotomies close the flat top nose and create nice dorsal aesthetic lines. In the majority of cases osteotomies do have to be performed when removing bumps off of the bridge of the nose.
Dorsal rasping of nose
Most rhinoplasty surgeons would advise you to have the nasal bones fractured after reducing your hump - assuming you wanted a significant reduction. If you're looking for a minimal reduction a consideration would be minimal reduction of the bridge with grafting of the radix of the nose (the part of the nose where it blends into the forehead). Another option would be injection of a filler into the radix. During a consultation these are the kinds of things that can be discussed. Personally I prefer the route of surgery with osteotomy for most patients but there are frequently exceptions to the rule.
Fixing Dorsal Hump Without Osteotomies
It really depends on your individual circumstances. Based on your photo, it appears the hump can be taken care of but you would most likely need to have osteotomies (narrowing of the nasal bones) performed. Failure to narrow the nasal bones may result in what we call an open roof deformity. When your surgeon shaves down a hump, this may leave an opening, which is located in the roof of the tunnel. Osteotomies would be performed to push the bones inward. In effect, this will close the opening. It is important to trust the judgement of your surgeon, and important to discuss any concerns you have during a consultation, where he or she will be able to provide you with all of the information necessary to make you feel as comfortable as possible prior to surgery. Thank you, and I hope this helps.
Rhinoplasty is Complex
Rhinoplasty is complex. You cannot just address one area without it affecting another area. It sounds easy to say "just take off the hump but leave everything else the same." However, if you take off the roof (hump) of your nose, then you will have an open roof. To close the roof, you need osteotomies so the bones can be pushed back together. Good luck with your procedure.
Why are patients afraid of osteotomies?
I hear this question almost every day---can you fix my nose and NOT break the bones? The idea of osteotomies is very upsetting to many patients, but it shouldn't be. Patients are generally under anesthesia for surgery, will not feel the osteotomies, and will heal in 1 week, regardless of whether or not they receive osteotomies.
In your case, you need hump reduction and ostetomies, as well as a graft to the radix (bridge). I would suggest consulting with a qualified rhinoplasty surgeon and listen to their advice about what you need. Reisit the temptation to place limitations on your surgeon. It's like asking a chef to make you a pizza, "but please don't use any dough!"
Can a dorsal hump be reduced without an osteotomy
Please look at your nose from the base...it looks like a pyramid, right?
What happens when one takes off the top of a pyramid...the pyramid looks wider. This is an optical illusion.
Looking at your profile, I believe the amount of dorsum which must be removed is large enough so that your nose will look very wide from the front.
You should not be afraid of osteotomies. It is a very common procedure done thousands of times a year, with minimal complication (if done by a trained surgeon).