Removing Dorsal Hump Without a Tip Strut or Graft?

asked 3 years ago by eire_245 in ireland
Latest answer by William Portuese, MD
Question viewed 760 times
Tags: nose, dorsal hump

Once the hump has been removed will my tip droop more, or is it possible to do without a columella strut to hold the tip up? What are the benefits either way?

8 answers to Removing Dorsal Hump Without a Tip Strut or Graft?

Tip struts are used if tip has poor support

It is possible to perform a dorsal hump without tip strut. Tip struts are only used when there is a very poor tip support as a preexisting condition. If the tip has good support to it, it does not need a tip strut. Once the hump is removed the sidewalls will most likely need to be narrowed with the rhinoplasty procedure.

William Portuese, MD
Seattle Facial Plastic Surgeon

www.seattlefacial.com

Hump reduction alters the nasal profile

When contemplating nasal hump reduction, one must consider whether to carry this removal all the way to the supratip region inferiorly or up to the radix (top of the nose) superiorly. If one performs a hump reduction alone, generally speaking tip position is not affected. However, if some dorsal septum in the area of the anterior septal angle (end of the septum near the tip), tip rotation is generally created to some degree. That is, the opposite of tip ptosis occurs. Also, the illusion of... more

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon

No columellar strut is probably needed

I'd have to see your nose to know how to provide what you want. Make sure you plan your nose on the computer first so you know what to expect. Your tip probably won't fall without a columellar strut graft. There are a lot of 'fads' in cosmetic surgery and columellar struts are one of them. Nature has designed the tip cartileges to stay up, and they usually do. The most common result of a columellar strut graft is to increase columellar show from a side view.

G. Gregory Gallico III, MD
Boston Plastic Surgeon

Tip and strut grafts are not always necessary.

Simply removing the dorsal hump by itself usually does not cause tip droop, unless significant disruption of other tip support structures in the process of getting to the hump. On the other hand, even when the tip is manipulated there are other methods, such as a columellar setback, that obviate the need for a strut. Because rhinoplasty is such a custom operation every time, these specifics are best left to your rhinoplastic surgeon. I particularly emphasize that no two rhinoplasties should... more

David C. Pearson, MD
Jacksonville Facial Plastic Surgeon

Will the nasal tip drop after dorsal hump removal?

It seems like a simple question, but it is fairly complicated. It really depends on how your tip is supported. If your nasal tip has good intrinsic support, then the dorsal hump can easily be removed via a closed approach if that is the only thing being addressed with the rhinoplasty, and the tip left alone. On the other hand, if you have a "tension tip", where the tip support is poor, and really is dependent on the caudal septum, then the tip projection will fall along with... more

Michael A. Bogdan, MD
Dallas Plastic Surgeon

It's about balance

Good question. It definitely depends on how big your hump is and the quality of the tip of your nose before surgery. Strictly speaking, downsizing a hump alone will not make your tip droop more or lift it for that matter. What can happen is that the relationship between the upper two thirds (the dorsum) of your nose and lower third (the tip) will change such that after the removal of a hump the tip can 'look' more droopy because it is no longer adjacent to a dominating big hump. If your... more

Farzad R Nahai, MD
Atlanta Plastic Surgeon

Columella struts are used to support the nasal tip

Dear Eire, I agree with Dr. Fechner. The only reason to use a graft like this is if you're having work done to the tip of your nose. If you're only having a bump removed, and you want your nasal tip to remain the same, you shouldn't need one. I hope this helps, and best regards.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon

www.ericmjoseph.com

Removal of Nose Hump and Tip Graft

The answer to your question has to be "it depends". If your tip support is good, no additional grafting may be necessary. If tip support is poor or borderline, tip graft, strut or both may become necessary. In most noses, the hump does not represent a major tip support component and the hump removal has little impact on the tip itself.