What is the Procedure for Shaving Down a Bone Bump Left from Rhinoplasty Healing?

Question

I had closed rhinoplasty about 8 months ago. (deviated septum, broken nose, hump) At my 6 week post-op visit, my doctor said that it appeared the bone had grown back kind of one piece on top of another on the top part of my nose. He said to wait about 6 months and then I could come back and it could be fixed in the office. The bump is still there but I am a little worried about getting it fixed..."shaving it down" while I'm not completely asleep sounds pretty horrible! How bad would this be?

Sam Naficy, MD, FACS · Answer

A minor bump revision can be performed internally (closed) under light IV sedation - local anesthesia may be OK for some but not my choice

George A. Toledo, MD · Answer

This is not an uncommon problem after a rhinoplasty. Even if the bony hump was adequately taken down during surgery, scar tissue can form during the healing process and can resemble a hump. Waiting a year is appropriate.
This revision can be performed under a local but I (and my patients) prefer some IV sedation. Sometimes the surgery is more involved after you get in there and having sedation is helpful.

Etai Funk, MD · Answer

6 weeks after rhinoplasty your swelling has only subsided about 50%-60% .  The skin over the dorsum or over the hump is the thinnest skin on the nose and should come down even more.  In addition, this skin probably swelled more than other surrounding skin as taking down a hump can cause some trauma to this area of the skin.  Your best bet is to wait at least 9-12 months depending on your skin type - thicker skin takes longer to contract and shrink. 

	Nevertheless, the nasal bone can regrow due to something called an osteoblastic response.  This is typically seen in younger patients.  Sometimes a revision needs to be done at 9-12 months to shave the hump down once more.  This can typically be done closed under twighlight or general anesthesia.

David Saadat, MD · Answer

Revision rhinoplasty is the right procedure and depending on the case this could be done in office with local anesthesia. Every patient is different so only through proper evaluation we can come up with a more solid decision and recommendations.

Ziyad Hammoudeh, MD · Answer

A residual bump following closed rhinoplasty can certainly be addressed with a minor revision.  If the bump is due to prominence of the nasal bones, the nasal bones can be shaved down with a rasp.  However, it could also be from prominence of the cartilage where it meets the bone.  In that case, the cartilage can be sharply trimmed.  Either of these maneuvers can be performed under local anesthesia in an office procedure room.  However, if you have concerns about comfort, I would recommend requesting sedation or light general anesthetic by an anesthesiologist in the operating room to make you the most comfortable as possible.  It is also important to note that at 8 months postop, you likely still have some swelling and inflammation in your nose that could make the bump appear more prominent than it actually is.  Therefore, I would recommend waiting a full year after rhinoplasty before pursuing a revision.  Best of luck in your recovery!
Ziyad Hammoudeh, MD

Gregory Roche, DO · Answer

In my experience, it would be done by using a rasp to file the bone and a scalpel to remove cartilage. In my opinion 6 weeks post surgery is too early to determine results.

Sergio Pasquale Maggi, MD, FACS · Answer

Hello, and thank you for your question regarding persistent dorsal fullness at 8 months.Without photos it is difficult to fully address your concern for a touch up procedure.  With that said, it is not uncommon to regain some dorsal fullness as one heals from a dorsal reduction.  This can be often attributed to:1. Residual swelling (this should improve over time) from the trauma of surgery.2. Development of scar tissue (if in the bony region of the dorsum this is referred to as 'callous') as you are healing in the area operated on (this may be improved by massage and softening, but may require a touch up).3. Formation of callous at the bony portion of the dorsum (this will require a touch up most likely)In the event that a touch up procedure is necessary, I recommend patience to allow sufficient time (from 7 to 12 months from procedure), and that the tissue is once again supple and softened.I hope this helped, and good luck with your healingSergio Pasquale Maggi, M.D., FACSAustin Plastic Surgery Centerdrmaggi.com

Pramit Malhotra, MD · Answer

After a large hump on the nose is taken down, either a new bony callus formation can give some of the "bump back" or sometimes as swelling subsides a remaining hump can be seen.  These are best corrected in the operating room where a rasp, or file, is used.  It is a very short procedure.

Garrett A. Wirth, MD, MS, FACS · Answer

The best procedure for you is the one that makes you the most comfortable.  With that in mind, taking down a bump on the nose can be done under local anesthesia, but you should consider a bit of sedation at the same time.  For more information, please go to my website at:WirthPlasticSurgery.com

William Portuese, MD · Answer

There is approximately a 10% revision rate for the rhinoplasty procedure. The most common reason for a revision after a primary rhinoplasty is to file a small bump down on the bridge of the nose. Sometimes the bump is comprised of bone, sometimes cartilage, and occasionally even both. This is simply a reflection of the healing process along the bridge and settling that occurs with the skin envelope of the nose. While shaving of a small bump down is a minor procedure, it is difficult to get the nose completely numb and can be rather uncomfortable trying to do this under local anesthesia. The nose has many different nerve endings and is difficult to completely numb up. It is painful to numb up the nose under local anesthesia to accomplish its minor touchup procedure. It is best to usually have even touchup procedures done under a very brief 15-minute general anesthetic.

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