Is shaving the bone necessary to remove a hump on the bridge of nose? (photos)

You are correct, you have a small nose. You don't need the hump reduce but a cartilage graft (supra tip graft) between the tip and the hump to make the dorsum straight.
Removing the hump might give you too much of a ski slope shape.
Regards
Dr. J

Firstly, I have to emphasize that the aesthetic outcome of the Rhinoplasty must be thoroughly discussed with your surgeon before the operation. In this case, I understand that you are reluctant to lose any of the height on the profile view of your nose. To answer your question, yes it is possible to perform this operation without any shaving of the bone, but rather focus on increasing the projection. I believe that your surgeon wants to do that because there will be also a dip if he doesn't reduce the height of the mid dorsum. in my opinion, if you don't want any height loss, you would require two grafts- one in the glabella and the other in the area underneath the bump raising to the tip.

Thank you for your question and photos.

In essence, the answer depends on the end result that she would like to achieve. There are 2 ways to help you decide about this:

- Computer imaging and simulation can give you a reasonably good assessment of the appearance on profile.

- Injectable filler treatment to the upper part of the bridge or upper part of the bridge and supratip can give you an evaluation of the correction from multiple angles. To some degree, a similar effect can be achieved also with computer imaging and simulation in 3D.

The bottom line with surgical interventions for cosmetic changes is that you should avoid doing operations that you are uncomfortable with. Evaluations in preparation for surgery have become increasingly more sophisticated to help answer questions like yours. They are not perfect, but in particular when in doubt you should try and evaluate the impact of these changes before having a surgical treatment.

Some surgeons would graft your bridge and others wouldn't. You are likely to get both recommendations. My advice? Choose the surgeon you feel you trust more.

Based on your photographs, your radix (root of the nose, between forehead and nasal bones) is slightly deep which creates a lower nasofrontal angle (you can Google that term to see what it measures). This can be corrected with a radix graft to add support to this area and improve the transition between the forehead and the nose. Below your nasal bones and before the tip is the "midvault" or middle 1/3 of your nose. Based on your photographs, your midvault appears to sink in and may require cartilage grafts to build structure and support. With building dorsal support at the radix and midvault, your nasal bones may require only minimal reduction.

Shave the bone versus graft: some surgeons would put a graft others would shave the bone some would do a little of each. I don’t think a graft alone would suffice .it would have to be too big and would leave you with an inadequate glabella notch. Also bear in mind that the bump creates what appears to be an indentation below it as well as above it ,therefore I would shave the bone primarily and may not even put a graft at all. But that is up to the patient and the particular taste and preferences of the surgeon as well

Hello,You have a mild dorsal hump. I think your nasal root looks okay. Options are to either rasp (shave down) the prominence or to build up the dorm just below this. It depends on what size you would like your nose to be. Rasping is certainly the easier option. Best of luck.JJ