Filing Down the Dorsal Hump Without Osteotomy?

I have a prominent dorsal hump. From frontal view you don't notice anything but on side profile there is clearly a big bump. My dorsal hump feels really irregular and uneven in bone structure (I also broke my nose 4yrs ago).

I was wondering if I could slightly reduce the bump (while keeping my tip of my nose the same) and have no need for an osteotomy (just filling off some of the bump even though it is big)

Doctor Answers 21

Rhinoplasty without osteotomies

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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.

Reducing dorsal hump

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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.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 188 reviews

Dorsal hump

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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.

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Addressing a dorsal hump in rhinoplasty: Is an osteotomy required?

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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.

Filing Down the Dorsal Hump Without Osteotomy in nose surgery?

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Small dorsal humps (sounds like yours is NOT) can be rasped a few millimeters; if more hump is taken off, you'll be left with an open roof and will need osteotomies.  These are just precise cuts in the bone, but the thought of "breaking the nose" frightens patients, and they frequently ask "Are you going to break my bones?".  You should consult with experienced facial plastic surgeons and trust the one you choose to do whatever necessary to achieve optimal results.  

Ramtin Kassir, MD
New York Facial Plastic Surgeon
4.7 out of 5 stars 155 reviews

Dorsal Hump Removal without Osteotomies

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You ask if you can "slightly reduce" the hump without osteotomies. More than a subtle reduction will make the nose flat and wider. Rely on the advice of your surgeon to determine what can be achieved. At least consider the osteotmies -- the result  of this surgery wiil last the rest of your life.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

Reducing hump without narrowing the nose

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Without examining you, I cannot give a definitive answer.

The nose (from the base) looks like a pyramid. Imagine filing the top of the pyramid down. If the base of the pyramid was wide to begin with, then the nose appears even wider from the frontal view. This is an optical illusion. If this is the case, then there is no harmony between the top of the nose and the bottom. An osteotomy is then required to narrow the upper portion of the nose.

Michael A. Jazayeri, MD
Santa Ana Plastic Surgeon

Big nose bridge reduction needs osteotomies, small one doesn't

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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.

Dorsal hump reduction without osteotomy is all about harmony

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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.

Filing down dorsal hump without osteotomy

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Without good photos the simple answer is YES! But again most likely you will need fracturing or osteotomies. See 3 boarded plastic surgeon in your area. Regards.

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.