I have a small dorsal hump that I would like to get fixed on my nose, and was considering closed rhinoplasty. The plastic surgeon informed me that he could just go in and file it down without breaking or fracturing any bones. Does this sound like a good idea? The absolute only thing I want done is the hump shaved down, and it is very small. Will any other part of my nose need fixing if the surgeon simply files the hump down?
Filing Down the Dorsal Hump?
Doctor Answers 75
Small or large dorsal humps can be reduced using closed rhinoplasty techniques. However, even with many small dorsal humps, the bones may need to be narrowed because once the hump is removed, the dorsum will appear wider and you may see and feel sharp edges of the nasal bones. The surgeon should be able to tell you by looking at the size of your hump if he/she would need to break the bones to make the dorsum narrower. Further more, even with small humps, spreader grafts (cartilage strips made of your own cartilage) may need to be used to prevent midnasal area collapse. Again, preoperatively, your surgeon should be able to assess if you need them or not. All these steps can be done through closed rhinoplasty.
The dorsal hump and the dorsal aesthetic lines
A small dorsal hump can be approached through a closed rhinoplasty technique. The dorsal hump can be addressed other by filing down the nasal bones for trimming the dorsal cartilage. It the hump is very small and is largely due to excess dorsal cartilage then nasal bone osteotomies may not be required.
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Filing down a nasal hump in closed rhinoplasty
If the only issue with your nose is the hump, you can absolutely have this addressed with a closed, or endonasal rhinoplasty. In most cases, the hump is comprised of both bone and cartilage and some combination of shaving, filing, and chiseling the hump is utilized.
The important preoperative assessments for the surgeon are the size of the hump, the degree to which the patient wants to lower the bridge, and the length of the nasal bones. If the patient does not desire a sgnificant bridge reduction ("finesse rhinoplasty") and the patient has adequate support in the middle vault, or bridge area, then simply filing/shaving down the hump may do the trick.
However, If the hump is larger and the nasal bones are on the shorter end, the upper lateral cartilages can lose support with time and the patient can develop an "inverted-V deformity". This can be avoided at the time of surgery with the placement of spreader grafts.
Lastly, if the humps is removed and there is an opening or flat area between the nasal bones (open roof deformity) then controlled fractures of the nasal bones (lateral osteotomies) may be performed at the time of surgery to close this roof and restore a normal appearance to the bridge.
Small nasal hump can be removed with a Closed Rhinoplasty
If the nasal hump is small and consists only of extra nasal bone a simply filing with a closed rhinoplasty approach is sufficient. If the hump is larger or involves the upper lateral cartilages of the middle of the nose than simple removal may cause a flat spot called an open roof deformity. When this is the case the nasal bones nee to be brought closed together by infracturing the nasal bones to recreate the natural pyramid of the nose.
Hump Removal via a Closed Rhinoplasty
Patients with a dorsal hump are ideal candidates for closed rhinoplasty. A dorsal hump is usually comprised of both bone and cartilage.
To remove a hump, an incision is made on the inside of the nose and a rasp is used to "file" the bony portion of the hump. If there is a cartilaginous component to the hump, this is trimmed with a scalpel.
One result of a hump removal is that it makes the bridge wider and may require osteotomies (breaking the nasal bones) to narrow the width of the bridge.
If your bridge is narrow, this may not be as much of a concern. However, if your bridge is currently a normal width or wide, hump removal with osteotomies may make your bridge even wider.
If your only issue is a dorsal hump, a closed rhinoplasty can be a great way to treat the contour of the dorsum with rasping. Rhinoplasty surgery is very complicated and the balance, shape and integration of the structure of your nose with the rest of the face is a critical consideration when planning what you do and don't need. In my San Francisco area practice we spend significant time analyzing the face. Make sure that your plastic surgeon spends considerable time discussing things like the projection of your nose, the angle of the tip, the shape of the tip of your nose, the shape and contour of your nostrils, the balance of your nose in comparison to the shape and projection of your chin, etc. (the list of things to review is actually quite extensive). If at that point your surgeon and you agree that it is only the dorsal hump should be addressed then a closed rhinoplasty is an effective way to treat this.
I hope this helps.
Steven Williams, MD
Why the nose usually has to be broken during hump reduction
Depending on your examination, you may require osteotomies during rhinoplasty surgery, after filing your small nasal bump.
Filing down the hump