Revision Rhinoplasty to Remove Bump with Rasping?

I had Rhinoplasty over a year ago and still have a bump. The bump is on the upper third of my nose and on the lateral aspect of the nose (on the right) and has been present since my cast came off over a year ago.

It is not swelling but palpable bone which from the oblique view is noticeable hump ( 2-3 mm). My question is can this be reduced by simple rasping and not involve osteotomies since the hump is not in the midline? Thanks.

Doctor Answers 11

Removal of Persistent Bony Hump after Rhinoplasty

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Without pictures or an examination it is impossible to answer your question. In some cases rasping alone is sufficient to eliminate the bump. Osteotomies would be necessary if rasping causes increased width of the nose or separation of the nasal bones. Send pictures if you want a more personal response.

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

Bony spicules after Rhinoplasty

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What you are describing is a common occurrence after rhinoplasty especially when the initial rhinoplasty involved hump reduction or infratcturing of the nose. It certainly is possible and likely in most cases to remove small residual hump with simple rasping and this is the most common type of revision in my practice. Generally, osteotomies are not required unless the hump is large and even if it is more midline if it is small can be addressed with simple filing. I hope this information helps.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Your nose bump may be an inverted V deformity

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I may be wrong, but it would bet that your bump is really not a true bump, but instead is the palpable lower edge of the nasal bone. This is something I commonly see in my patients seeking revision rhinoplasty. What happens is that a hump is removed during rhinoplasty. Usually, this involved removal of bone and cartilage from the bridge of the nose.

One effect of this is that it creates a separation of the upper lateral cartilages (the cartilage that forms the middle 1/3 of the bridge of the nose) and the septum. The cartilage then collapses inward, while the bone above stays put. Since the lower border of the bone is no longer flush with the cartilage below, it feels like a bump. When both sides collapse, the entire lower border of the nasal bones becomes palpable and sometimes visible, the so-called inverted V-deformity, since the lower edge of the nasal bones have an upside-down V orientation.

Both the prevention and treatment of this problem is the same: spreader grafts (cartilage grafts placed to expand the area of collapse).

Revision rhinoplasty to remove a bump on the nose

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 The revision rhinoplasty procedure can be  performed to shave down the dorsal hump. The dorsal hump is usually composed of either bone or cartilage, or both. A very small hump can be simply rasped, while  a moderate to significant hump will require osteotomies of the nasal bones.
For may examples of hump removal, please see the link below to our rhinoplasty photo gallery

Persistent bump on side of nose

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The persistent bump is most likely at the juncture between the upper lateral cartilage and the bony dorsum. This can be easily treated with rasping if it is bone.

Revision Rhinoplasty

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I would need to see photos and/or perform an examination to give you the best advice. If the bump is on the side, it is unlikely you will need osteotomies. Please send any photos, and I would be happy to evaluate them for you. Thank you, and best of luck.

Dr. Nassif

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews

Persistant Nasal Hump

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I have to disagree with the other comments posted above. While no studies, to my knowledge have supported a relationship between lasers and fillers we have definitely seen a relationship clinically in my office. We first noticed a diminishing of results from fillers with our own staff members several years ago when Fraxel laser treatments were performed after injecting Restylane and Juvederm. We eventually narrowed it down to a time period of 2 months following injection of the hyaluronic acid filler when it seemed to be vulnerable to laser treatment. We also did a side-by-side comparison on several staff members, using Fraxel laser on only one side of the face after filler injections and did see a reduction in correction within 1-2 days after laser treatment.

My theory on this is that hyaluronic acid fillers bind water and Fraxel laser, among many other lasers, are attracted to, and therefore heat up, the water molecules in the skin. This could account for its effect on the fillers. We have also seen this effect with GentleYag laser and SmoothBeam laser. Because of this effect, we have avoided use of other lasers and IPL devices within 2 months of injecting fillers.

Because of this effect we have even used lasers to intentionally diminish fillers after poorly done treatments were done by other offices. We found this helped with Radiesse injections also, so the effect may not be limited to just hyaluronic acid fillers such as Juvederm and Restylane.

I don't know if IPL or Thermage have the same effect because we avoid all heat-producing treatments in the skin for 2 months after all filler treatments now, but I have to assume that the heat produced by these techniques will probably diminish the filler to some degree. I would wait 2 months after your filler is placed before having laser treatment.

Residual Bump After Rhinoplasty

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Secondary or revision rhinoplasty is, without question, the most challenging cosmetic surgery for both surgeons and patients. Even though there may be just a small bump that could easily be shaved, if you have to cross a lot of anatomy to get there - you could "damage" some of the "good" portions of the nose along the way. Frequently, an internal approach can be used to "rasp" or file down a prominent bone and easily solve your problem in 30 minutes. However, sometimes what you are seeing is a collapse of the surrounding tissues that may need to be lifted or repositioned to restore balance/symmetry.

It sounds as if this is a bone inadequately treated (which can easily occur) and you would need to have this treated as I described. The oblique (3/4) view often makes this type of "bump" the most noticeable as it demonstrates the prominent nasal bone in an un-camouflaged manner. Osteotomies are unlikely, but this is impossible to rule out without a full examination.

Best of luck and discuss this with your surgeon.

How to deal with a persistent bony bump after Rhinoplasty Surgery.

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If your bridge is at a good height (not too high), but you see an edge of bone on your oblique view, you might be a good candidate for an Injectable Filler treatment. A small amount of Injectable Filler can often act as a cushion between the thin skin of the upper nose and your visible nasal bone. Silikon-1000 would be my filler-of-choice for a permanent result.

You should leave surgery as a last resort. I can't comment whether you'll need osteotomies without seeing your photos. Feel free to email me photos and a description, and I'll be happy to share my thoughts with you.

I hope this is helpful for you.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 430 reviews

Residual persistent hump/bump after nose job (rhinoplasty)

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It is difficult to say without an examination but, to me, it sounds as if this is the distal most end of the right nasal bone. This could be treated with rasping or may reflect incomplete infracture which could necessitate osteotomies. In some instances, these can be complete percutaneously. Discuss your findings with your surgeon. Now that a year has passed, it is reasonable to re-assess your results at this time

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.