Rasping Dorsal Hump Sides?

Question

I have a small dorsal hump (in height) which is flared out on the sides. I am male, and I don't want the height of the hump to change; I just want the width to be narrower. The last surgeon I saw suggested rasping the sides and leaving the bridge, which is what I want. Two other surgeons want to break the bone. I don't want my nose to look very different, I just want the sides of the hump gone. Does rasping sound like a reasonable procedure?

Michael A. Persky, MD · Answer

Hi Selida,
You want a subtle rhinoplasty. It is possible in many cases to just rasp the lateral nasal bone prominence and shaving down any lateral cartilaginous wing to narrow your nose without breaking the nasal bones. In other cases, lateral osteotomies (incising the nasal bones) are all that is needed.
The key to successful rhinoplasty is proper diagnosis of what is creating the deformity that you wish corrected. Your rhinoplasty surgeon should be able to let you know what can be done in your particular case.
It sounds like less is more in your case. It is always easier to go back and take off more (or perform osteotomies) than to have to undo something that was overdone.
Do choose your rhinoplasty surgeon most carefully, and make sure that you are on the same "page".
Be well.
Dr. P

C. Spencer Cochran, MD · Answer

A dorsal hump is usually composed of both cartilage (lower 1/2) and bone (upper half). Either, or both of these usually need to be reduced when a hump removal is performed. If the prominences on the lateral sides of the hump are bone, rasping (filing down) can correct the problem without changing the height of the bridge. If the prominences are cartilage, they can be trimmed from beneath the skin. A closed approach, regardless of what needs to be reduced.

Behrooz Torkian, MD · Answer

Selida,
I have had patients in whom reduction of the width is necessary without reduction of the bridge, and in most cases, osteotomies were needed.
The bones may be thinned by rasping, but only to a certain extent.  The limiting factor is going to be how much bone can be thinned without collapsing the top of the bridge.
A more direct approach is called the "reverse spreader" approach.  This is where the dorsum (bridge) is narrowed by removing precise wedges of bone from the paramedian (just along the midline) portion of the bridge.  The dorsum is then left with an openning in its roof.  This is closed by breaking the bones with medial and lateral osteotomies.  The amount of narrowing can be approximately 1-2mm on each side.
Depending on how much narrowing you really need, this may be the right approach for you.  Good luck - wish you a speedy recovery.
Dr. T

Toby Mayer, MD · Answer

It depends on the width of the bridge. If the rasping of the prominences narrows the bridge, this will work. The bones don't have to be broken.

S. Randolph Waldman, MD · Answer

Many times the problem you are referring to is caused by cartilage and in this case rasping can be helpful. In the case of a bony prominence it is my experience that only minimal deformites will respond to rasping alone. Obviously it would be helpful to see pictures.

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