The dorsal hump is composed of both bone bone and cartilage and can be shaved down during the rhinoplasty procedure. Once the dorsal hump has been shaved down, it leaves the nose with an open cap, open roof, flat top nose during the surgery. Osteotomies of the nasal bones are then absolutely required to narrow the bridge line and close the open roof deformity. While the osteotomies create swelling and bruising across the cheek, they did not create very much additional pain with the procedure, as long as there is no packing placed on the inside of the nose by your surgeon. For many examples of hump removal with osteotomies, please see link and the video below