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.