Would you recommend a tip refinement for dorsal hump removal? (photos)

Question

I'm anxiously awaiting rhinoplasty and hope to select a dr soon for the procedure. I met with one who indicated no tip refinement was necessary, but everything I read says its unusual for a large dorsal hump to be removed without some tip refinement? I meet with the second plastic surgeon next week but wanted additional input as I see lots of helpful expert opinions here...thank you!!

Toby Mayer, MD · Answer

Tip plasty for only bulbous tip. If your tip is not bulbous then you just need hump removal without any tip work which I have done frequently over the past 35 years.

Ben Lee, MD · Answer

While it is possible to remove a dorsal hump and do nothing else, almost every nose could stand some tip refinement in the form of a cephalon trim of the lower lateral cartilages. It just adds balance.

Eric M. Joseph, MD · Answer

Based on your photo, you appear to have a long nose with a droopy tip and a large profile hump. A more feminine nasal appearance may result from both hump removal along with tip repositioning. If your surgeon does nothing except remove your hump, ligaments from your bridge to your tip may be disrupted, and you could end up with a droopier tip. Hump removal, along with tip rotation and support would be my suggestion, based on your profile photo.Hope this helps you.Dr. Joseph

Darryl J. Blinski, MD · Answer

Thanks for the RealSelf posting. YES I always recommend some tip and columella refinement to dorsal hump removals, especially to add a more feminization effect.

Peter E. Johnson, MD · Answer

We feel it is unusual to complete the hump reduction without adjustment of the tip both in shape and projection of the tip relative to the new dorsal height. In our practice a complete rhinoplasty would be best. Best luck with your search.

William Portuese, MD · Answer

A full set of pictures are required to make a decision regarding the tip of the nose. The decision to perform tip surgery is usually made when patients have a bulbous tip seen from the frontal view. As long as the tip cartilages are adequate, a tip procedure is not necessary, only the dorsal hump removal. A dorsal hump is composed of both bone and cartilage must be shaved down in order to remove it. Osteotomies of the nasal bones are then required to close the open roof deformity created from the hump removal. For many examples of hump removal with and without tip surgery, please see the link and video below

Paul M. Heath, MD · Answer

I would certainly concur with previous comments about putting too much credence on an online review of a single profile photograph, and that a personal consultation is clearly necessary before making any decisions.  However, in many patients with noses similar to yours, a hump removal is often very helpful in achieving an attractive nose.

Robert Singer, MD · Answer

In the appropriate patient, the dorsal hump can be reduced without doing anything to the tip. It depends on your individual anatomy and desired outcome.Keep in mind that following the advice from a surgeon on this or
any other website who proposes to tell you what to do based on a limited two
dimensional photo without examining you, physically feeling the tissue,
assessing your desired outcome, taking a full medical history, and discussing
the pros and cons of each operative procedure would not be in your best
interest. I would suggest you find a plastic surgeon certified by the American
Board of Plastic Surgery and ideally a member of the American Society for Aesthetic
Plastic Surgery (ASAPS) or facial plastic surgeon that you trust and are comfortable
with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD
FACS

La Jolla, California

Michael Elam, MD (retired) · Answer

Dear famoffive, Rhinoplasty surgery is performed to refine the patients nose allowing a more balanced aesthetic appearance to the entire facial aesthetics. During most rhinoplasty procedures and certainly in yours all aspects of the nose should be addressed to allow a natural looking well balanced feminine appearance.  You don't cut out portions of the procedure and not address the tip in both shape and projection. Best regards, Michael V. Elam, M.D.

Would you recommend a tip refinement for dorsal hump removal? (photos)

Answers (9)

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