Could the hump on my nose be subtly filed down without resorting to an osteotomy? (Photo)

Hello, it really depends on how much bone/cartilage will be taken down. If removal of the bone/cartilage leaves a flat wide appearance to the top, then you will most likely need an osteotomy to close the wide dorsum. If the contour after filing down the bone and contouring the cartilage is acceptable...then you may not need the osteotomy. 

It is possible to just shave down the bump on the nose. Think of the cross-section of the nose as a pyramid. The more the tip of the pyramid is shaved off, the wider it will appear.  That is how the front view of the nose behaves.  The larger the bump that is shaved down, the wider the front view of the nose appears. The reason for osteotomies (moving in of bones)  is often to counteract this widening effect of removing the bump. Dr. B

The whole hump can be reduced without osteotomy but sometimes it can leave a flat dorsum. In that case you have no option but to do osteotomies to bring the nasal bones closer to get a narrow dorsum.regardsDr J

Good morning and thank you for your inquiry. Filing always looks more natural than fracturing nasal bones, as long as an "open roof" is not left behind. The nose should be understated and conservative, always with an eye towards a natural result. Modern surgical tools and precision grafting can be employed to remove the bump yet preserve the nasal pyramid. Remember: aesthetically, less is more, particularly in a man.

 The dorsal hump is composed of both bone and cartilage and must be shaved down surgically in order to remove it. Shaving down this dorsal hump will result in a "flat top" open roof deformity. Osteotomies will be necessary to close the open roof deformity.   For many examples of dorsal hump removal with osteotomies of the nasal bones, please see the link below

If you are willing to accept some aesthetic trade-offs, your hump can simply be rasped. Those trade-offs are the following: 1) very little hump reduction will occur and a residual hump will still remain, 2) the bridge of your nose will likely appear more flat, and 3) the transition between the nasal bones and the upper lateral cartilages will become more apparent. While rasping a nasal hump always seems the most appealing, one has to be aware that the results are usually not the same as a more complete approach to the nasal problem.

The hump can be shaved, but if it appears pretty flat then osteotomies will be required.  Best of luck with your decision to move forward.

Of course it depends on how much is removed and whether or not the contour of your nasal dorsum is acceptable after rasping but just based on your photos, and not having examined you, I have a feeling you will need osteotomies..

We don't chose to do osteotomies if not needed.  When you file more than the thickness of the bone,  say  one millimeter or so, you get an open roof deformity: a flat bridge with sharp edges. That is what you close when you do an osteotomy. In your case, if you have surgery , be prepared to have an osteotomy. Don't place a limit on what the surgeon should do.

I am frequently asked this question. A decision cannot be made without an examination but I doubt that the hump cannot be completely removed without an osteotomy to avoid increasing the width of your nose. I have had some patients that decided to not completely remove the hump, avoiding the need to fracture the nasal bones.