Cartilage bumps or lumps after Rhinoplasty usually mean they were not removed
It is not uncommon to see small cartilage lumps and bumps after Rhinoplasty if you look very closely at the nose. The problem of course is that larger lumps are visible and can be seen.
It is unlikely in my experience (30 years) that new cartilage will grow after a Rhinoplasty and create a new lump or bump.
The one exception is when Rhinoplasty is done on an adolescent who has not finished growing. If you have a Rhinoplasty before your facial growth is complete (ie during adolescence and before puberty is completed), new cartilage and sometimes bone growth does occur and can ruin an otherwise good Rhinoplasty result.
That is why we do not do Rhinoplasty until facial growth is complete, and puberty is passed.
Most commonly lumps and bumps after dorsal hump reduction are caused by small cartilage chips or bone chips that are left behind or when inadequate cartilage or bone removal has been achieved during Rhinoplasty.
Cartilage bumps can come after a hump removal
Cartilage bumps can come after a hump removal. This is usually related to osteogenesis of both bone and cartilage from the removal site. It also occurs as the nose settles in and down, where bumps can become more apparent, especially in thin-skinned individuals.
Cartilage bumps and lumps can form after rhinoplasty for different reasons:
1. When the skin and soft tissue swelling resolves over time, small bumps and lumps left over from the surgery can be revealed (like the rocks on the shore during low tide). Non-surgical rhinoplasty filler treatments can help small defects and irregularities. Surgery may be necessary larger problems.
2. During the healing process the soft tissue can contract and thicken especially above the nasal tip, to leave a supra-tip fullness. Compression strips and sometimes steroid injections will help improve this problem.
3. During the healing process the cut ends of bone and cartilage can form a healing scar tissue ridge or bone callus. A callus is an exudate and connective tissue from bone edges that forms during the healing process. In my experience the size of this scar tissue or callus varies from patient to patient. Compression strips can help with small ridges, larger lumps may need a second surgery.
4. Buckling of cartilage due to scar tissue contraction - especially in the tip. These “Bossae” form bumps in the nasal tip that usually require additional surgery to correct.
The best rhinoplasty surgeons understand these causes and attempts to prevent them or treat them appropriately once they form. If you develop these problems, I recommend seeking a Board Certified Rhinoplasty Surgeon comfortable performing revision rhinoplasty.
Cartilage does not form lumps, but irregularities may appear after swelling subsides
There might be occasionally a slight irregularity at the nasal dorsum after the hump removal. It can be overlooked at the time of surgery and show up after the swelling goes down, usually in a couple of months after surgery. It is usually due to bony irregularities, but in rare instances it can be due to cartilage.
Several factors contribute to this: patient's anatomy and size of the hump, experience of the surgeon, diligence and attention to details of the surgeon. Sometimes speed is not the best thing in nasal surgery. Cartilage lumps or bumps usually do not form, but may be left behind if the surgeon is not meticulous and rushes through surgery. Nasal cartilage may also shift during healing, especially if they are not fixed with sutures.
During hump removal, we take down the top of the septum and the cartilages attached to it. It is usually necessary to reattach the cartilages to the septum with sutures to prevent future collapse, deformity, breathing problems, and also formation of the irregularities. Frequently we have to place little grafts to further improve the shape and prevent these problems. Again, if the doctor does not take the time and care to do this part well, irregularities may show up in the future.
Irregularities can occur after dorsal hump removal
Just like scarring in the skin, bony scar or cartilage can regenerate and develop small lumps on the dorsum of the nose. More likely are irregularities that are present at the time of surgery that only become apparent after the swelling has resolved.
Lumps and bumps can re-form after rhinoplasty. These can be due to cartilege or bone, or even the healing of these tissues. The cartilege can warp and become visible later, after initially looking great. If this happens, it doesn't indicate that the doctor or you did anything wrong.
Cartilage bumps don't "form" after nasal surgery
However, often as the swelling goes down after nasal surgery the patient may notice the normal tip cartilages which may be more prominent. The same is true over the prior hump. One may feel or see the bone more than before depending on what was done. You should discuss this with your surgeon.