Does filing down a dorsal hump always create an “open roof”?

Answer from Dr. Sean Hill, Board-Certified Plastic Surgeon at Lone Star Plastic Surgery in Frisco, TX:
This is a very insightful question — and an important one when planning rhinoplasty surgery.
When a dorsal hump is removed, especially if it involves both bone and cartilage, it can leave what’s called an “open roof deformity” — essentially a gap between the nasal bones that can create a flat or widened appearance from the front. To correct this and restore a more natural, narrow nasal contour, osteotomies (controlled fractures of the nasal bones) are often performed. This allows the bones to be repositioned inward, effectively “closing the roof” and maintaining balanced nasal width.
That said, osteotomies are not always required. In cases where the hump is small or composed mostly of cartilage, or in select patients with thicker soft tissue coverage, a surgeon may be able to achieve a smooth and natural result without performing osteotomies.
The decision depends on your unique anatomy, the size and shape of the hump, and your aesthetic goals. At Lone Star Plastic Surgery, I assess each patient’s nasal structure in detail to determine whether osteotomies are necessary to achieve an optimal, natural-looking outcome.
As always, be sure your surgeon is board-certified and a member of The Rhinoplasty Society, which ensures they have advanced expertise in the nuances of nasal surgery.
Warmly,Dr. Sean HillBoard-Certified Plastic SurgeonLone Star Plastic Surgery – Frisco, TX

However it is very good and commendable you try to understand this concept, the most common cause for a revision rhinoplasty; I'll be brief and plain:
-the nasal pyramid is like a tent of a house's gable roof
-if you chop away part of that roof, aka the nasal hump... you get an open roof with exposed walls' edges
-you have to move the walls together to create a new roof (who wants the rain to pour into the living room?); that is done by fracturing THE BASE of the roof, very near the maxilla (so that the infracturing is invisible) and moving both walls together in contact to each other and allowing healling between them

Failing to do so after removing the hump leads to a typical and inevitable combo:
-open roof deformity: ridges of the walls (and the septum) are visible through the skin, gaps between them visible too like two slots, also broad dorsum (the larger the hump removed the broader the resulting dorsum)
-inverted V deformity: the soft walls of the nose made of cartilage at the lower half of the glable roof do close spontaneously the roof, no need for fracturing, however they close too much and fall inwards the septum, dislocating themselves from the non-fractured nasal bones and hence creating a gap with an inverted V shape

Hope I helped to clarify this very important concept, known since 1905 when Dr. Joseph invented rhinoplasty (he taught all us about the open roof and the need of infracturing). See below at the link a longer explanation.

PS: You may wonder... why surgeons fail to do the osteotomies if this is such A-B-C lesson nº1 of rhinoplasty?... easy... fear and incompetence.

I cannot remember one instance in the last 26 years where we did not perform osteotomies after removing a dorsal hump from one of our patients, during rhinoplasty surgery. This leads to temporary bruising, but it is not painful, and I believe the end result is worth it, and completely necessary. I hope this helps! Sincerely, Dr Joseph

Hello and thank you for your question. It is necessary to perform osteotomies in order to close an open roof deformity after after rasping. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Depending on the amount that is filed down, you may not have no roof. Also, if you have a minor open roof, you can file the sides as well and maybe make it look normal. However, you may need an osteotomy to close the open roof, if it is significant.

Best Wishes,

Gary Horndeski, M.D.