How is Osteotomy for Dorsal Hump Done?

I have a slight dorsal hump, but I was informed that it can be flattened. The base would be narrowed with osteotomies and tip re-defined. The doctor told me that the hump is slight, but osteotomies (breaking) is necessary in my case, but I'm not sure how osteotomy is accomplished by rasp or other instrument, since mine would be an open not closed procedure. Thank you for any input.

Doctor Answers 6

Osteotomy during dorsal hump removal

A very slight dorsal hump is usually removed with rasping or knife and scissors, not an osteotomy. Both medial and lateral osteotomies are performed with a small chisel and a hammer at a very precise location to narrow the nasal bones and close the open roof deformity that is present after a hump is removed. If the osteotomies are not performed, a flattop open roof deformity will result, which will be very unnatural in appearance. Osteotomies are performed through either an open or closed technique. The difference in the open rhinoplasty is an incision across the columella, and the closed technique is the incisions are all placed on the inside of the nose

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Removing dorsal humps and infracturing the nose

There are numerous techniques for removal of a dorsal hump including rasping or filing it down, shaving it down, or removing it as a whole piece, and combinations of each. Entire courses at plastic surgery meetings are devoted to these subjects and which technique is best used when. In addition, the techniques for infracturing the bone are also many and varied but fundamentally include going through the skin with tiny 2 mm chisels and going up through the nostril. Ask your surgeon which techniques he or she prefer and why.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Nasal humps can be reduced in many ways

Nasal humps can be reduced with a rasp (looks like a file), with an osteotome (similar to a chisel) and for some old timers, a saw. Once the hump is removed there is usually small gap on the top. This is because removing a hump is similar to taking off the top of a pyramid. That leaves a gap called an open roof.

Osteotomies are then performed with a tiny osteotome to mobilize the nasal bones. The nasal pyramid (triangular bones) then can selectively tilted inward to close the open roof or pushed inward to narrow the upper third of the nose at the same time. This is "breaking" the nose. It is necessary for a good result in most rhinoplasties and despite popular opinion actually makes most results better than if not performed.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 125 reviews

The hump is removed with a rasp (file) or chisel.

 Osteotomies are performed on the sides of the nose to narrow the nose after the hump has been removed. Understanding what and how nasal surgery is done is not as important as selecting an experienced rhinoplasty surgeon who has many skills in his "bag of tricks".

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Dorsal hump removal...

The dorsal hump is a combination of the nasal bone above and the cartilage below. In most patients, the cartilage represents the majority of the the hump. However, the methods to achieve reduction include chisels, rasps, and a scalpel. Most surgeons use a combination of tools.

When the hump is removed, the nose may look flat on top. To make it have a more natural roundness, the nasal bone above are broken laterally at the level of the cheek and moved slightly inward causing the flatness to appear rounded.

An open or closed rhinoplasty does not change the need to do the above maneuvers.

Ricardo Izquierdo, MD
Oak Brook Plastic Surgeon
4.0 out of 5 stars 8 reviews

Osteotomies for dorsal hump

Dear Harlie kay,

You really should make sure you understand what YOUR surgeon is telling you since it will be him/her doing your surgery.

The nasal dorsal hump is made up of a lower cartilage nous component (which is taken down either in component fashion or in block with a scalpel ) and an upper bony component (which is taken down by either rasps, a wide chisel or a power burr). Once the hump is removed, the side walls need to be moved centrally to close the roof. This is done with a narrower chisel placed either through the nose skin (per cutaneous), through the nose along the side wall or by some through the mouth. All of these are personal choices used to effect the same result.

I hope this was helpful.

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 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.