How much would a dorsal hump shave cost, & can an ENT perform this? I don't want full rhinoplasty. Who is best in QLD? (Photo)

Question

After perlane inserted into my nose on 2 occasions, my dorsal hump is once again appearing. Have had the liquid nose job fail, and have seen the Dr he suggested surgery before getting a permanent filler inserted due to the risk of infection with a foreign body.

James Bonaparte, MD, MSc, FRCSC · Answer

Injection rhinoplasties are good for some people, and as you noticed they are temporary. The only way to get a long term result is with a rhinoplasty (surgery on your nose). From looking at your photo's, i am somewhat suspicious that just shaving the bump down on your nose may not be the  most idea surgery. Its a little hard to tell, but you may have another issue that is actually making the bump look bigger than it really is. The bump on your nose is the transition between the bone and cartilage part of your nose. To me, the bone is a little high, but you may also have an under projected nose. This means, you have a short distance from the tip of your nose to where your nostril attaches to your face. The only want to know for certain is to see you and measure, but I have a suspicious. The problem is, if you simply shave down the bump without confirming this, it may make your nose look REALLY small for your face. I just thought i'd mention that as you need a good assessment. It would be usefull to do some digital imaging and virtual surgery with you to see how reducing the bump changes your facial profile. As for ENT, ENT or Head and Neck surgeons, at least in Canada are trained in facial plastic and cosmetic surgery. ENT only operate on the head and neck and many with ENT or Otolaryngology surgical training have considerable nasal surgery experience. Furthermore, we can do extra training with the American Academy of Facial Plastic and Reconstructive Surgery. If you look on their website, you can see who is also certified by that organization. James P. Bonaparte, MD, MSc, FRCSCAssistant Professor, Department of Otolaryngology – Head and Neck SurgeryOtolaryngology – Head and Neck SurgeryFacial Plastic and Reconstructive SurgeryOttawa, Ontario, Canada

Inessa Fishman, MD · Answer

Rhinoplasty, the act of reshaping the nose, is one of the most difficult procedures in facial plastic surgery.  The non-surgical or "liquid" rhinoplasty you've experienced involves temporary or permanent fillers injected into the nose to camouflage bumps and/ or fill in depressions.  Surgical rhinoplasty involves reshaping or cartilage and/ or bone by excision, suturing, addition of grafts, etc.  Your photos, while limited, suggest you would benefit from takedown of the dorsal hump, slight tip rotation, and chin augmentation.  An in-person exam and evaluation are necessary to determine whether any other procedures (such as septoplasty) are beneficial and whether you're a good, healthy candidate.  Because surgical rhinoplasty/ nasal surgery is individually tailored to every patient, "full" vs "partial" rhinoplasty are terms with no standard meaning among rhinoplasty surgeons.ENTs, facial plastic surgeons, and general plastic surgeons are all generally trained in rhinoplasty.  Your best first step is to research rhinoplasty surgeons and meet with one or several to discuss your treatment options.  A well-qualified rhinoplasty surgeon has a keen understanding on facial and nasal anatomy and physiology, performs rhinoplasty surgeries regularly, can show you a group of before and after photos, and discusses the details of surgery, recovery, revision rate, complications, etc. plainly with you.  You must find a person with these qualities and make sure you develop a good rapport with him/ her.  Doing so and discussing a clear, thorough treatment plan are the best initial steps to a great outcome.  Prices vary by region and physician, and should not dictate your decision in choosing a provider; this website is helpful for you to get an idea of prices and physicians in your region.  Good luck!

William Portuese, MD · Answer

Unfortunately, you are looking at the nose from  only one dimension which is the side profile. A dorsal shave can be performed to reduce the nasal hump. An open roof deformity will be  created which requires osteotomies placed in the nasal bones to close the flat top, open roof deformity  that results from  the hump removal. The tip of the nose may or may not need to be adjusted as well. Remember, the nose is a three-dimensional structure and the side profile is only one dimension. Rhinoplasty is the hardest operation to perform in the entire field of cosmetic surgery, so choose your rhinoplasty surgeon very wisely, and make sure they have lots of experience to get it done right the first time. In addition to being board certified in ENT, look for a surgeon who is double board certified in ENT and in Facial Plastic Surgery with extensive experience in rhinoplasty. The cost of a rhinoplasty in our practice is located  on the link below

Clyde Mathison, MD · Answer

It is tough to tell from only a set of pictures, but it appears that an endonasal dorsal hump take down would improve your nasal profile.  Additional surgical maneuvers may be necessary, such as lateral osteotomies to correct an open-roof deformity (as one physician already mentioned), but one would not be able to fully comment on this without having the opportunity to examine your nose. Regarding qualifications of cosmetic surgeons, all ENT's are trained in basic facial plastic surgery, but only a few are board certified facial plastic surgeons.  Whomever you choose, they should have experience in rhinoplasty, and perform rhinoplasty frequently (not 1-2 times per year).  Most importantly, though, you should be comfortable with them.  Good luck!!

Peter Callan, MBBS, FRACS, MBA · Answer

Hi there.While your request sounds simple, you must be careful!  A dorsal shave is only possible in the most minimal of humps, because the nose is hollow.  Taking off much more than the smallest amount has many unintended consequences that must be addressed or your nose will not look harmonious and balanced.Looking at your nose a dorsal shave will not work for you.  It will take off the roof of the nose, leave it open, and too wide. You may also lose support of the side walls (the roof holds the side walls out) and the side walls may collapse. Your nose may then look operated upon and breathing could be affected. The entire balance of the nose needs to be addressed.You need to see an experienced rhinoplasty surgeon, look at some imaging, and see what is achievable.  Rhinoplasty is great procedure for you, but it must be done properly so as your nose looks good, functions well, and stays that way.Whether your surgeon is ENT or a Plastic surgeon does not matter.  What matters is that they are a good rhinoplasty surgeon, and both specialties have excellent rhinoplasty surgeons.I hope this helps.

Scott Shadfar, MD · Answer

Hello Pretty_Nose13Thank you for your question.Without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of any further treatments it is difficult to be comprehensive.I think that a simple hump takedown is warranted.  There is something to be said to trusting your face to a facial plastic surgeon.The cost can vary based on the surgeon.I would seek out a facial plastic surgeon to discuss your options.  This can likely be done endonasally in  a very short procedure.Best of luck, Dr. S

Shady Hayek, MD - Account Suspended · Answer

Thank you for sending those photos. I think, from what I see on those photos, that simple rasping of your hump will not be sufficient. It will lead to an open book deformity where by the dorsum of your nose will be wide and deformed and with a thin skin like yours you might even see the details of the separated bones underneath. To prevent this you will need osteotomies that will help reshape your nose and bring those bones together to close the tip of the pyramid again. My suggestion is to check with an ASAPS member well versed in nose surgery who can assess you in person and give you the plan that suits your current situation and the look you wish to have.Best,Shady Hayek, M.D.Beirut, Lebanon

How much would a dorsal hump shave cost, & can an ENT perform this? I don't want full rhinoplasty. Who is best in QLD? (Photo)

Answers (7)

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