I’m removing my small dorsal hump, will I need a graft during a closed rhinoplasty? (Photo)

Hi @Lilly Salcido. Typically when a dorsal hump is removed, the nasal bones need to be broken for a good outcome. You may also require spreader graft placement to prevent the upper lateral cartilages from falling inward. Best of luck, Dr. Nima!

Though your bump is not terribly large, it involves both cartilage and bone. You will most likely need in-fracturing to narrow the bridge after hump removal. You might also need to have your tip either stabilized or have the projection increased slightly because the dorsal hump is a minor support holding your tip up!

In most cases where a hump is removed the nasal bones need to be broken to get the best result. Otherwise your nose will look too wide even if only a bump is removed. I would not use a graft but there are plenty of surgeons who would. Nothing wrong with that.

When removing the dorsal hump that you have, osteotomies performed in the nasal bones will be required to close the open roof, flat-top nasal deformity created from the hump removal itself. You may also require spreader graft placement to prevent the upper lateral cartilages from falling inward. Some minor tip adjustments may also be required. All this can be performed with the closed rhinoplasty approach with the incisions completely placed on the inside of the nose.

You must ask yourself if you have clearly expressed your goals to your surgeon and are you reasonably certain your surgeon understands how to achieve those goals. Do you want a profile that is slightly convex, straight or slightly concave? Your bump is quite sizable and if the goal is to have a straight profile then you will likely require spreader grafts or flaps to reconstruct the middle-third to avoid deformities like open roof and inverted V. If the goal is to create an even more feminine profile (slightly concave) then projection of the tip (requires grafts) will be necessary in addition to removing the dorsal hump. Shaving down a bump is more complicated than it seems to most patients. First of all, bumps are about 80% cartilage and only 20% bone. Very small bumps can be removed without breaking the nose bones or adding stabilizing grafts/flaps but the vast majority of bumps will require these additional maneuvers. The alternative to traditional hump removal is preservation rhinoplasty. This technique is done through a closed approach and can lower bumps of all sizes without requiring any stabilizing grafts and carries no risk of open roof or inverted V deformities. Proceeding with rhinoplasty requires the patient to be certain of his/her goals and the surgeon to be confident in his/her operative plan to achieve those goals.

Hello,From the single view you submitted it is difficult to give you the most complete answer...........however in general reducing your dorsal hump should not require grafting unless your surgeon wants to graft any cartilage to your nasal tip area or other areas to reshape your nose. I am not sure what you mean by an inverted V deformity.