After Hump Was Removed In Primary Surger, My Nose is Flatter and Wider. Can I Get It Back To Where It Was?

Question

I had a small bump removed that used to lay directly where my bridge started. Now, with it gone, my nose looks much wider and flatter. It has been six months since my primary - is there any way to make my nose less wide and flat? Is it possible to have the bump put back?

Steven J. Pearlman, MD, FACS · Answer

When a hump on the nose is removed, it can make the nose appear wider. If you measure the actual width it is unlikely to actually be wider. This is an optical illusion caused by unmasking of the eyes. A smaller hump separating the eyes gives the appearance of this area to look flatter and wider.

	Another condition that may occur is a flat upper nose (dorsum) with an open roof. Removing a hump is akin to shaving off the top of a pyramid. Unless you do osteotomies, or "break" the nose, the area may appear flat. The open roof occurs when you see the edges of the nasal bones that weren't brought back together after removing a hump with these osteotomies.

	There are two ways to fix the above conditions, first is to perform osteotomies to narrow the nasal bones. The second option is to restore all or part of the hump.

William D. Losquadro, MD · Answer

Removing a hump is analogous to removing the apex of a triangle-the more that is removed, the wider the remaining portion becomes. Hump removal often requires simultaneous narrowing of the nasal bones so that the nasal width is appropriate on the frontal view. The nasal bones can easily be narrowed during a revision procedure. Bumps can be recreated, but require grafting material such as septal cartilage.

Thomas A. Lamperti, MD · Answer

A couple possible causes of the wider appearing nose after hump removal include:

	
		There is an open roof deformity such that the bridge it too flat and the bones wider than ideal. This can be treated with osteotomies to gently infracture the bones and shift them toward the midline.
	
		Simply removing a hump can give the perception that the nose is wider.


	Seeing your nose would help determine what would be the best way to address your concerns. The bridge can be built back up if you desire. This is usually done by grafting some of your own cartilage.

Shepherd G. Pryor, MD · Answer

The answer is absolutely. Essentially when taking down a dorsal hump deformity, if too much is removed, you create what is called an "open roof deformity." The nose goes from a triangular shape to a rectangular one. If recognized appropriately at the time of surgery, or is planned for, then lateral osteotomies will renarrow the dorsum and recreate a triangular shape. At this stage now, what you may benefit from is both augmentation of your dorsum to give you more height and better shape as well as osteotomies. Visit with your original surgeon to discuss these issues and see if improvement can be made or seek a second opinion from a specialist who has a high degree of success with revisional surgeries.

Robert Kotler, MD, FACS · Answer

Hello, Manhattan friend.

	What you are describing is a classical situation. When the bump was removed, it may be that the nasal bones were not moved closer to each other. Thus there is the illusion of increased width ( the nose is not wider, just looks that way since there was no narrowing done.

	Then, there is the flatness, as if someone came along with a sword and sliced off the bridge of your nose. In a sense that happened.

	Here is the good news: it can be fixed. The next surgeon will merely move the two nasal bones closer to each other. You then should have a more narrow nose and the mobilized bones, when they come together will restore the normal anatomical relationship.

	Remember, seen from " below", the bridge of the nose is triangular shaped. What you have now is a nose that is in the shape of a trapezoid. Not exactly what Nature planned. But, salvageable.

	 

	- Robert Kotler, MD, FACS

	  Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON

Richard W. Fleming, MD (retired) · Answer

You say that you want your old nose back, but I suggest that you narrow the bridge without replacing the hump. Careful evaluation by your physician or an experienced revision rhinoplasty surgeon will determine what should be done to improve your result.

George J. Beraka, MD (retired) · Answer

Hi.

	1)  As some of the other doctors say, you probably have an "open roof" deformity.  This can be corrected by bringing the nasal bones and cartilages closer together to "close the roof".  This procedure is called "in-fractures".

	2)  It is also possible that too much of the hump was removed.  This is corrected with a small cartilage graft.

Jay M. Pensler, MD - Account Suspended · Answer

First a photo would be helpful. Second there a many options for revision rhinoplasty. The options are adjusted to the specifics of your anatomy.

Francis R. Palmer, III, MD (retired) · Answer

Without pictures, it's difficult to evaluate but you'd want to be certain that you do not have an open roof deformity. This occurs when a nasal bony hump is removed wothout breaking the nasal bones towards the midline. If this is the case a revision Rhinoplasty where the bones are broken would be required. This would not give you the hump back but would narrow the nose and close the open roof deformity, if one exists.

After Hump Was Removed In Primary Surger, My Nose is Flatter and Wider. Can I Get It Back To Where It Was?

Answers (9)

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