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