Filing Down the Dorsal Hump?

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.

Thank you for your inquiry!



It seems that you are a good candidate
for a conservative rhinoplasty that will improve the way your nose looks to complement your
facial features in a natural fashion. If the dorsal bump is cartilaginous in nature, then osteotomies (shaving down the bone) may not be necessary. However, without a physical
examination it is not possible to provide you with specific details. I highly
recommend that you schedule a consultation with a well-experienced surgeon.



It is important to mention that the
finest cosmetic results in any particular case are based on a variety of
factors, including: the unique anatomy of the patient, realistic expectations,
a well-informed and detailed discussion with your plastic surgeon concerning
the best options for you especially covering a deep understanding of the pros
and cons of any given choice you will adopt.



Please keep in mind that following the
advice from a surgeon online who offers to tell you what to do without a
physical examination covering the nature and the status of the tissue,
assessing your desired outcome, taking a full medical history, and discussing
the pros and cons of each operative solution would not be in your best
interest. With that in mind, it is the safest and for your best interest to
find a plastic surgeon with solid experience and certified by the American
Board of Plastic Surgery who is ideally a member of the American Society of
Plastic Surgeons that you will trust and be comfortable with. You should
discuss your concerns with that surgeon in person.



Good luck!!!



Ali Sajjadian, MD FACS

Hello,The closed rhinoplasty is the best way to remove bone and cartilage in hundreds of micro-millimeter slivers to slowly and carefully sculpt the profile to the perfect balance. If your dorsal hump is small enough you will not need anything else done to the nose. On occasion, once you change the dorsal hump the nasal tip needs to be defined as well. All the best, Deepak Dugar, MDScarless Rhinoplasty ExpertBeverly Hills, CA 90210

A dorsal hump can be filed down easily through a closed rhinoplasty incision by a surgeon experienced in closed rhinoplasty technique.  Whether or not that will change the shape of your nose will depend on the preoperative shape of your nose, the amount of hump and the skill of the surgeon. 

In the majority of cases the nasal bones have to be infracted after bony nasal hump reduction to avoid a "open roof deformity".  There are some exceptions.  If you have a tiny hump with an already narrow bridge the hump can be shaved down as long as there is no open roof post shaving.  This will also help improve the appearance of a narrow nasal bridge giving it a more normal appearance especially in situations where the tip is wider for a more balanced look.  The second scenario is if the dorsal bump is mostly made out of cartilage and there is no open roof deformity after hump reduction.  This situation has the greatest risk for inverted v deformity if spreader grafts aren't placed for support post hump reduction. 

Filing a nasal bump may not be as easy as it sounds. The majority of nasal bumps start where the nasal bones meet nasal cartilage. Cartilage is not easily removed with a file. Additionally, after removal of a dorsal hump, there tends to be widening of the nasal appearance on front view, and osteotomies may be necessary to keep your nasal appearance narrow on front view.Hope this helps.Dr Joseph

So if the hump is VERY small you will be ok and the closed approach is fine.  However if its medium then you create whats called an open roof deformity which will require other manuevers to correct.  Additioinally you may shave down other important structures like the upper lateral cartilages with the hump that can later lead to breathing issues and poor aesthetic results.  Make sure you locate a skilled surgeon who can guide youGood luck

Isolated small dorsal humps can be taken down via a closed technique without osteotomies.  The dorsal hump is usually composed of both cartilage and bone.  The bone is easily lowered by rasping, but the cartilage is too springy and rasping does very little.  Cartilage is usually taken down sharply (this can still be done through closed techniques).  If the bump is larger, then osteotomies will be required to close the "open roof" that will make the dorsum look wide and flat on frontal view.

If the dorsal hump is truly small, it can be approached via an internal approach and simply filed down. Larger hump removal can leave an open roof in the nasal for sum, necessitating Infracture of the nose. This does not appear to be the case here

Without seeing your pictures, I can only make some generalized comments. Being trained in both open and closed rhinoplasty, the only reason that I do closed rhinoplasty any more is for a isolated hump reduction. That being said, there is usually some tip work that needs to be done and an open rhinoplasty is so much better for that portion. There are a few cases that I do see that truly require soley a hump reduction and a closed rhinoplasty is perfect for those.

If the hump is small it can certainly be filed down without breaking the bones through a closed approach. If the bump is larger, then the nasal bones will need to be brought in to regain the proper shape of the nose. It is most important to find an experienced surgeon who knows which way it needs to be done.