Filing Down the Dorsal Hump?

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?

Doctor Answers 78

Definitely yes

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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.


Los Angeles Plastic Surgeon
4.5 out of 5 stars 337 reviews

The dorsal hump and the dorsal aesthetic lines

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It is common for patients to have 1 or 2 things that really bother them about their nose. One of the most common concerns that prompts patients to seek rhinoplasty is the dorsal hump (bump). In many instances there are other aspects of the nose that could be improved simultaneously during rhinoplasty; some common problems include tip shape and position, crookedness, and poor nasal airflow. However, often times these problems are imperceptible to the patient presenting for rhinoplasty as they are focused on their major concern. Following surgery, these other problems may be more apparent to the patient once the major concern has been addressed. Additionally, reducing or reshaping the dorsal hump alone can cause a change in the relative proportions of the nose leading to an unbalanced look. Finally, reducing the dorsal hump without adequately addressing the nasal bones and transition point from the bones above to cartilages below can lead to several deformities and a suboptimal look. When widely situated bones are not osteotomized (broken) and moved in after the hump is taken down, problems including excessive width at the site of the dorsal hump on frontal view or an inverted-V deformity (upside down shadowing in the shape of a V on frontal view) may be created. The dorsal aesthetic lines can also appear flared and irregular in the area of the hump. The dorsal aesthetic lines are visible on frontal view and are the right and left light reflections that start at the medial aspects of the eyebrows, gently taper inward, proceed in straight down the right and left sides of the dorsum and then gently taper outward at the tip. Creating smooth and straight dorsal aesthetic lines should be a goal as well when reducing a dorsal hump as problems from the frontal view are very bothersome to patients since most of the time that we tend to see ourselves is straight on while looking in the mirror. Ill-defined or irregular dorsal aesthetic lines tends to be a common complaint from patients seeking revision rhinoplasty.

Dorsal hump

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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.

Edward S. Kwak, MD
Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 28 reviews

Filing down a nasal hump in closed rhinoplasty

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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. 

Regards,

Dr. Mehta

Umang Mehta, MD
Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 52 reviews

Small nasal hump can be removed with a Closed Rhinoplasty

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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.

Andrew Jacono, MD
Manhattan Facial Plastic Surgeon
4.7 out of 5 stars 215 reviews

Hump Removal via a Closed Rhinoplasty

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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.

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
4.7 out of 5 stars 149 reviews

Closed Rhinoplasty

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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

Isolated dorsal hump removal

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Thank you for this great question which many patients contemplating or undergoing this procedure are sure to ask. Dorsal humps can be bony, cartilaginous or in the majority of cases, a combination of both. If a dorsal hump is pretty large, then removal will result in a flattened appearance on the top of the nose called an "open sky deformity" which usually requires osteotomies (surgically breaking the nasal bones to move them in) to correct. If the hump is small, however, it may be removed without having to do additional procedures such as osteotomies. A small, isolated dorsal hump is indeed something that could be addressed through a closed approach (only internal incisions). An in-person consultation with a Rhinoplasty specialist is recommended to learn about your options, and don't forget that seeking out a second opinion is also quite useful if you have any questions/concerns. Hope that helped! Best, Dr. Roy.  

Closed Rhinoplasty

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Hello,

The closed rhinoplasty is the best way to remove bone and cartilage in hundreds of micro-millimeter slivers to slowly and carefully sculpt the profile to the perfect balance. If your dorsal hump is small enough you will not need anything else done to the nose. On occasion, once you change the dorsal hump the nasal tip needs to be defined as well. 

All the best, 

Deepak Dugar, MD
Scarless Rhinoplasty Expert
Beverly Hills, CA 90210

Deepak Raj Dugar, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 20 reviews

Filing down dorsal hump

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A dorsal hump can be filed down easily through a closed rhinoplasty incision by a surgeon experienced in closed rhinoplasty technique.  Whether or not that will change the shape of your nose will depend on the preoperative shape of your nose, the amount of hump and the skill of the surgeon. 

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.