Procedure to Reduce Dorsal Hump

Thanks for the question! Removing a hump while maintaining the shape of the rest of the nose can certainly be accomplished through either closed (endonasal) or open (external) rhinoplasty. This can be achieved by rasping (filing) down the bones or using a very precise osteotome, similar to a chisel. There are many considerations, however, which are important to assess.

1) First of all, I would recommend seeking a surgeon who performs computer imaging during the consultation. This process allows the surgeon to demonstrate to you how your nose may look following hump removal surgery. You may find, during this exercise, that there are other features of your nose which may need to be tweaked in order to maintain balance with your other facial features and your new lowered bridge. I use this process during every rhinoplasty consultation to determine the patient's aesthetic sense and explain to the patient what would be realistic and achievable given the patient's unique anatomy. 

2) Secondly, it is critical to assess the length of the nasal bones and to determine if the hump is mostly bone, cartilage or both. One of the most common problems I see when patients come to my office seeking a revision of a rhinoplasty performed by another surgeon is what we call the inverted-V deformity. This occurs when a hump is removed and the cartilages on both sides of the nasal bridge (upper lateral cartilages) fall in. This results in a "pinched" middle third of the nose with the area just below the nasal bones looking like an upside-down "V". Narrowing of this area can also affect your ability to breathe by pinching the internal valves of your airway. This outcome can be prevented by identifying patients at risk of developing this issue and placing small thin cartilage grafts on each side of the top of the septum (spreader grafts). 

3) The third thing to think about is that when a hump is removed, there can be a gap between the tops of the nasal bones along the upper part of the bridge of the nose, called an "open roof deformity". The gap can be closed by making small controlled fractures along the sides of the nasal bones (osteotomies) to bring in the nasal bones. 

My best advice to you would be to schedule a consult with a few surgeons who specialize in rhinoplasty. It is worth the extra time to find a surgeon with whom you feel comfortable.

Best,

Umang Mehta, MD

Reducing the dorsal hump is one of the most common requests from patients seeking a rhinoplasty. It is possible to isolate this area during the surgery, however it is important to make sure that your nose, as a whole, will still have a balanced and symmetrical appearance. Creating an appropriate aesthetic relies on how the forehead transitions into the bridge of the nose and how the bridge of the nose transitions onto the tip. For this reason, consulting with an experienced rhinoplasty surgeon in person will give you an even better idea if you are a candidate for just a dorsal hump reduction, or if other areas of your nose need to be addressed during surgery.

It is common to reduce a dorsal hump if you are going to do an asthetic natural looking rhinoplasty. However, there is really no such thing as a simple hump removal in most cases because one has to place the dorsum and tip in harmony with the rest of the face. If it is just a simple dorsal hump removal, one can do that endo-nasally to rasp it down, but in most cases it requires an open rhinoplasty to refine the nasal tip and the dorsum to produce a natural looking nose.

Hi intrepid13,

Thank you for sharing your photographs. Yes, reducing a nasal bump may be a relatively minor procedure, as compared to other rhinoplasty procedures. Computer imaging could help determine how your nose may look like after bump reduction.

Rhinoplasty is not one operation, but many potential operations. Every patient is unique. Reducing the hump from a nose is the most common request for cosmetic nasal surgery. Humps are usually made up of both cartilage and bone, and come in various sizes and shapes. Reducing small humps is a relatively easier procedure, as compared to more extensive rhinoplasty surgery. Large bumps will require bone reshaping/breaking after the hump is removed.

A goal in nasal surgery is to recreate balance of the nose with the rest of the face. A small hump may be filed or rasped without needing more surgery. A subtle change in the nose may create a profound improvement in facial balance. Occasionally, complementary facial surgery may be recommended along with the rhinoplasty to help improve overall facial balance, such as chin implant or augmentation.

Only after a comprehensive nasal evaluation can a rhinoplasty surgeon help determine the most appropriate option for you. Best of luck.

Dr. Chaboki

I read your question and reviewed your photos. You appear to have a long nose with a profile bump, and droopy tip that worsens with smiling. In my opinion, you would obtain an optimal result by addressing all of these issues, not just your bump. Your nose will continue to lenghthen as you get older, so if you're inclined to undergo a major operation you may want to consider nasal shortening, and tip rotation as well.

You may want to consult several reputable, experienced rhinoplasty specialists to see what would be best for you.

I hope this helps you.

Regards from NJ:

Rhinoplasty or nasal surgery to remove a dorsal hump or bump on the nose may sound fairly straight forward.  However, other techniques must be incorporated in order to respect the aesthetics and function of the nose.  If the hump is taken down alone, the bridge or dorsum of the nose will seem like the top of an aircraft carrier (an open roof deformity).  Flat and wide.  The bones on the side of the nose need to be fractured and brought inwards inorder to "close" this open roof.  

In addition, the nasal valve may be effected when a hump is taken down.  This is the area of highest nasal airway resistance.  It is important to respect this valve and reconstruct it after hump removal.  Otherwise, nasal function may be compromised.  

Reducing the dorsal bump of the nose is one of the most frequently performed procedures in rhinoplasty. Small bumps can often be treated by reducing the bone and cartilage directly beneath the bump. Large bumps may require reduction and repositioning of the remain supportive structures to avoid making a flat spot on the nasal dorsum.

This is usually a simple procedure. Computer imaging is very helpful in these cases. While it cannot be a guarantee of results, it can greatly facilitate the decision of how much reduction is enough. By defining the goal before surgery, the chances of a result you will be happy with are greatly increased.

A very limited rhinoplasty consisting of rasping of the dorsal hump may be all that is necessary if this is the only part of the nose you wish to address. The procedure can even be performed with conscious sedation, avoiding the need and cost of general anesthesia. I recommend using a 3D system such as the Vectra 3D by Canfield so that you can visualize the effect of the hump reduction on the overall harmony of your face.

This is not difficult but you need to go to an experienced rhinoplasty surgeon who does natural noses that are not over done.

A subtle dorsal hump removal can be done while maintaining the other aspects of your nose, if you want.

As others have mentioned, it is important to assess whether you would be at risk for pinching of the middle third of your nose as a result of surgery. If this is the case, cartilage spreader grafts can be placed concurrently to add support to the area and prevent this problem (aesthetically and functionally).

It may be illustrative to go through computer morphing with your surgeon to see what extent of change exactly you're looking for. This also allows your surgeon to know that you do indeed want the other aspects of your nose to stay the same.

Hello and thank you for posting photos. Reduction of a nasal hump is a very common maneuver performed as part of a Rhinoplasty. What's more important however is to determine what reducing the hump will do to the overall appearance of the nose and face. It's hard to tell from the angles in the photos provided, but it seems that you may have some tip ptosis. Sometimes some slight tip elevation in conjunction with hump reduction can make the nose look much more natural than just taking the hump down. I would suggest you have a computer imaging session with your surgeon of choice and see what the different options would look like for you.