Filing Down the Dorsal Hump Without Osteotomy?

Yes, you certainly can have rhinoplasty without osteotomies. It's done rather frequently in fact. Bone cuts (lateral osteotomies) are made at the sides of your nasal bridge. They narrow the middle part of the bridge of the nose. They have little effect to the root of your nose between the eyes nor the base of your nose above the lip. They have no effect on your nasal hump. As your bridge is lowered, the width of your bridge becomes greater. At some point it becomes too wide and lateral osteotomies are needed. So like most decisions in cosmetic rhinoplasty, its a matter of aesthetic judgement.

When a bump of more than 1-2 mm is removed, it usually will require osteotomies to avoid widening and flattening the top of the nose (unless the nasal dorsum is overly narrow to begin with).  The video above discusses why.

Removing a dorsal hump ABSOLUTELY requires osteotomy to avoid a unaesthetic and progressive deformity called 'open roof deformity.'  Essentially filing down the bony pyramid of the nose removes the roof of the pyramid which would lead to a strange contour and appearance if left alone.  An osteotomy allows the roof to close back to a pyramidal shape and allows an aesthetic result.  Be very wary of a surgeon who promises you a dorsal reduction without an osteotomy.

 

All the best,

 

Rian A. Maercks M.D.

The more the bridge is lowered, the flatter the nose looks and the more likely an opening (open roof) will occur on the bony bridge. Osteotomies can remedy both of these undesirable side-effects.
If the bridge is lowered just a bit, osteotomies may not be necessary. An alternative to creating a nice profile in the presence of a small hump is to augment the bridge above the hump and elevate and project the nasal tip forward a bit.
If osteotomies need to be performed, a skilled surgeon should be able to create a smooth and natural shape without problems.

To simply answer your question, yes you can only have the hump reduced but you must understand that there should be harmony between the bridge of the nose and the tip. The nose is the most central portion a persons' face and if the nose is not harmonious among its parts it can disrupt the overall facial aesthetics. Rhinoplasty is not simplistic.
1. When the hump is reduced this creates a wide nasal bridge. Osteotomies help narrow the nose.
2. Once the bridge is narrowed this may create a mismatch between the bridge and the tip. (the tip may look bigger). So some refinement of the tip may be warranted.
This is cosmetic procedure where you have input but during your evaluation your surgeon should direct to the pros and cons of "selective" alteration of one portion of the nose.
Rhinoplasty is an elegant operation and when planned and performed correctly will produce excellent results.
Good Luck.

The nose is a pyramidal structure. Reducing a hump makes the nose wider. That is the main reason for performing an osteotomy, or narrowing the top of the nose. Filing alone can result in a "boxer's nose", one that is flat and wide.
Your plastic surgeon can guide you through what decision to make, and on how to maintain the breathing or improve it even if the dorsum of the nose is being narrowed.

Hi,
It depends on your anatomy, but in many cases, the dorsal hump can be filed down without the need for osteotomies. A subtle rhinoplasty tailored to your individual needs can be obtained, just make sure that you choose your rhinoplasty surgeon most carefully. See the below web reference for more on the "subtle rhinoplasty".
Good luck and be well.
Dr. P

Small residual nasal humps can gently be filed down especially if they are the result of trauma with a rasp. This can often be done without doing osteotomies to narrow and infracture or break the nose. However, if the hump is very large and you file it down to provide a smooth profile, then you will need to do osteotomies to narrow the nose and close the flat spot called an "open roof".
This is analogous to building a house. If you take down the roof it is open unless you push the walls closer together. A small hump can be simply filed away. The other part of your question keeping the tip the same is possible with or without osteotomies. In fact, even if osteotomies are needed you can leave your tip position and shape alone.
I hope this information helps.

 This can be done by filing it down only when the hump is small. Otherwise the nasal bones will be apart and flat. This is why we have to do osteotomies when we remove the average sized hump.

Yes, you can perform a slight bridge correction with rasping alone, but it is for very select patients. One, is that patient that has a very subtle dorsal hump, and I would agree that 1 mm is about all that can be safely removed. Any more than this, and the rasp will uncover the intranasal cavity, which shows up externally as a slight single or double depression on each side of the septum that runs vertically in the upper third of the nose. As mentioned, the second part of an open roof deformity means the remaining nasal bones are wider than the original dorsal line, so paradoxically the bridge actually appears fatter. For this reason, most patients undergoing bridge reduction rhinoplasty require additional steps called osteotomies to infracture the bony pyramid and correct this deformity.
The second patient that is a candidate for dorsal rasping without osteotomies would be those with small focal irregularities. Whether from a fracture, prior rhinoplasty, or post surgical graft irregularities, small bumps can often be addressed this way as well. Very safe and predictable and variable based on need. I have even narrowed a few dorsal lines this way by conservatively shaping only the side of the bony pyramid peak that creates the line that defines the top of the nose.
One last idea. In select patients, meaning those that are tough, or not troubled by surgical procedures, I have done these also under local anesthesia only (or you could add a mild oral sedation pill). Wierd for patients, still it still requires local anesthesia too, but tolerable, and saves recovery time and money.