Shaving or most minimal procedure for dorsal hump reduction? (photos)

Question

Just wondering if I could achieve a straight nose (remove hump completely) with shaving dorsal hump and can it be done without general anaesthesia?

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your
photograph, you may benefit from a conservative dorsal hump reduction.  In my practice, I perform this under general anesthesia with a board-certified MD anesthesiologist in the room at all times.  Often when reducing a dorsal hump, otsoetomies must be performed to smooth the dorsum and prevent an open roof deformity.  This is not possible using local anesthesia.  Make sure you specifically look at before and after
pictures of real patients who have had this surgery performed by your surgeon
and not just a computer animation system. The most important
aspect is to find a surgeon you are comfortable with. I recommend that you seek
consultation with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Mark Been, MD · Answer

Thanks for your post. The short answer is yes--you can certainly have your hump shaved without general anesthesia. That being said, you may not have the best aesthetic outcome if that's all you do. It may be necessary to reposition the nasal bones and perform some tip work to make sure all areas of the nose are in good proportion to one another. It is always best to consult with an experienced rhinoplasty surgeon in person where computer imaging can be performed to show you what is possible from surgery. He or she can also discuss what type of anesthesia is used. Best of luck!

Mark Hamilton, MD · Answer

Thank you for your question and sending images. Of course it is impossible to make an exact diagnosis and plan without a full consultation and exam. That said, it does appear that you have a dorsal hump that could be corrected with rhinoplasty.While taking down a hump may seem to be a simple shaving of the nose, this really is not the case. Often bone as well as cartilage must be removed to achieve an ideal aesthetic profile. Once this is done, the dorsum will actually appear wide and flat (open roof deformity). To correct this, the nasal bones must be manipulated to move toward the midline to bring the nose back into proportion. There are other issues that may need to be addressed as well. So not just a simple shave.Could this be done without general? I have heard of surgeons in the past doing this with local and I can not imagine what a terrible experience that has to be for the patient. When the surgeon breaks the nasal bones, you would both feel the hammering and hear it- so it is possible for a highly motivated patient, but not something I would recommend. At the very least you would want a deep twilight anesthesia, which is often done.I would recommend consulting with a board certified facial plastic surgeon to explore your options.

Pouria Moradi, MBBS, FRACS · Answer

Thanks for sending through your images and goals.Your goals are very achievable but certainly not without general anaesthetic.The type of anaesthetic should not be your limiting factor in having the surgery but rather finding a surgeon who you can trust to give you the best results.I hope this helps and good luck.

Peter Callan, MBBS, FRACS, MBA · Answer

Hi there and thanks for the question, a common one I find which needs an explanation.The short answer to your question is no. You will be disappointed with the result. The attractive nose is a question of balance, and from the photos you have provided the entire nose will need to be balanced to give you a good aesthetic result. The approach you are asking for is how rhinoplasty was done over 30 years ago. This approach led to destabilisation of the nose, imbalance and results that did not last, as well as functional disturbance.As the nose is hollow, shaving down the hump removes the "roof", so opens up the top of the nose. Not only does this leave the roof open, it destabilises the lateral walls. the cartilaginous components of which will fall in, giving what we call an "inverted V".While it is true that a minimal hump reduction will not do this, the result would not really be worth your while I feel. You need to let your surgeon do a proper, aesthetic and functional rhinoplasty.I hope this helps.

Jon F. Harrell, DO, FACS · Answer

When removing the excess tissue from the bridge the nose will look wider and wider from the front view as the bridge is reduced more. For this reason the nasal bones are repositioned after lowering the bridge. This is accomplished by a controlled osteotomy. This would be sufficient for you based on your concerns. So yes, you could simply shave the bridge down, but you will also need to slightly narrow the bridge as well. This procedure can be done under sedation, thereby eliminating the need for general anesthesia. Best of Luck  Dr Harrell

Darryl J. Hodgkinson, MD, FACS, FRCSC (retired) · Answer

Using a rasp after intranasal access to the roof of the nose allows for the surgeon to gradually remove the nasal hump..This can be performed under general or local anaesthesia.Before surgery during consultation a digital image of exactly what you are trying to achieve is advisable.

Shaving or most minimal procedure for dorsal hump reduction? (photos)

Answers (7)

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