Dorsal Hump Removal

What Is Dorsal Hump Removal (Nose Surgery)?

The most common reason people ask for rhinoplasty (nose surgery) is to remove a hump from the bridge of the nose. Also known as a dorsal hump, this nasal feature is more obvious in profile view but affects the appearance of the face and nose from all angles.

Surgery to remove the dorsal hump should take into account the whole person including facial features, needs, and background. Good plastic surgeons listen to their clients’ needs and use their artistic and surgical experience to create great results.

Thinking About Dorsal Hump Reduction or Removal

People tend to be born with the potential to develop a dorsal hump. This is more common in people of particular ethnic backgrounds, including people of Persian, North Indian or Pakistani backgrounds.

After plastic surgery, our clients often want their appearance to reflect their ethnic, cultural or family identity. Surgeons should design noses in harmony with each person’s individual needs.

People who want their face to appear more feminine may also ask for dorsal hump removal or reduction. For men who prefer a masculine appearance, a reduction in hump size might be more suitable as total hump removal can make the nose appear too feminine.

It is important to discuss your preferences and let your surgeon know if you want your nasal hump removed or just reduced in size. For those who prefer to minimize changes to their appearance or maintain their cultural or family identity, hump reduction might be the best option.

Planning For Dorsal Hump Removal or Reduction

The experienced rhinoplasty surgeon will perform a detailed analysis of the nose and all aspects of the facial and profile angles including the:

• Forehead shape
• The angle between the nasal bridge and forehead
• Radix height – the height of the point where the nose meets the skin between the eyebrows
• Supratip break – the projection of the tip slightly beyond the line of the nasal bridge or nasal dorsum
• Nasal tip dimensions
• Tip projection
• Infratip break – the underside of the nasal tip lying immediately above the nostril openings
• Angle formed between the columella (cartilage and skin between the two nostrils) and the upper lip as seen in profile
• Length of the upper lip
• Contact between your upper and lower teeth
• Chin projection

Given the importance of all these measurements, changes to any of these features will affect the overall look of the face. Dorsal hump removal or reduction should be considered in the context of any additional facial cosmetic surgery.

Removing or Reducing the Size of the Dorsal Hump

The upper third of the nose is made up of bone and the middle third is cartilage (upper lateral cartilage). This means a dorsal hump can be made up of bone, cartilage or a combination of both. For this reason, removing or reducing the size of a hump can involve surgery on bone, cartilage or both.

A number of surgical approaches are available to remove or reduce the size of dorsal humps. The approach should be planned based on your anatomy and your needs. Choosing an experienced surgeon is important to decrease the risk of secondary or revision rhinoplasty, which is an issue after hump removal.

Some of the common issues needing special consideration are described below:

Thick Skin and Dorsal Hump Reduction

If the overlying skin is thick, changes made to the underlying nasal bone and cartilage may not make an obvious difference in appearance. This is because thick skin does not always shrink around the nose after surgery. Your surgeon should use approaches to minimize this issue.

Stabilizing the Nose After Dorsal Hump Surgery

The middle third of the nose often needs to be stabilized after hump surgery so that:

• The nose does not drop over time to create a nose bridge that curves inward or scoops
• The middle of the nose does not collapse to create an “inverted V deformity” or other structural problems
• Breathing does not become more difficult

Spreader grafts can help stabilize the middle of the nose after hump removal. These are small strips of cartilage or bone inserted on either side of the wall dividing the two nostrils (septum).

Narrowing the Nose After Dorsal Hump Surgery

When larger humps are removed, the nose can look too wide from the front. In these cases, the surgeon can cut the bone to narrow and change the shape of the nose (osteotomy). Osteotomies can affect breathing so other rhinoplasty procedures such as spreader grafts can be used to improve airflow.

Revision or Secondary Rhinoplasty

One of the most common types of rhinoplasties that Dr. Deschamps-Braly performs is the correction of a previous surgeon’s work. Revision rhinoplasty is a surgical procedure performed when a nose has already had surgery to repair its shape and/or internal function. Revision rhinoplasty is one of the most common of all revision plastic surgeries, partly because “nose jobs” are difficult and clients are not happy with the results.

Revision or secondary rhinoplasty is more complex than primary rhinoplasty surgery so proper planning, an artistic sensibility, and vast experience is needed to reduce the risk of revision surgery.

Reasons for revision rhinoplasty after dorsal hump reduction or removal include:

• Insufficient changes to the appearance of the hump – can be caused by thick skin
• Dorsal hump recurrence – more likely in people with larger humps
• Residual dorsal hump – more likely if not enough cartilage is removed
• Inverted V deformity – can occur if the bridge of the nose was not stabilized during hump reduction surgery
• Inward curving or scooping nasal bridge – can develop over time if the bridge of the nose was not stabilized during hump reduction surgery

Hump recurrence or residual humps are more likely with:

• Larger humps
• Longer and higher nasal bones
• A conservative approach to the rhinoplasty

An experienced surgeon will understand all these issues and use approaches to give the best possible aesthetic result while reducing the risk of revision surgery.

Surgical approaches such as the use of spreader grafts to support the nose can help decrease the rate of rhinoplasty revisions after hump surgery. The risk of residual humps can increase when a less experienced surgeon chooses a conservative approach and does not remove enough cartilage.

If you are considering dorsal hump surgery, discuss your needs with a plastic surgeon who has vast experience of rhinoplasty and an artistic eye.

Planning Decreases the Risk of Dorsal Hump Recurrence

Dr. Deschamps-Braly is a Board Certified plastic and craniofacial surgeon specializing in facial plastic surgery, orthognathic (jaw) surgery, and craniofacial surgery for adults and children.

During a consultation, Dr. Deschamps-Braly will listen to your concerns and conduct a thorough physical examination of your nose. He will photograph you from several angles, including your profile and other features. Dorsal hump removal needs the careful measurement of all dimensions of your nasal structure and all aspects of your face.

Thick skin and soft tissue can mask the underlying surgical changes of rhinoplasty. If this is the case, Dr. Deschamps-Braly will discuss the best approach.

Once Dr. Deschamps-Braly fully understands the anatomy of your nose, your facial features and the changes you would like, he will use his experience and artistry to design a nose that he believes will give you the best possible result.

Recovering From Rhinoplasty

Immediately after surgery, a splint and surgical tape will be applied to the bridge of the nose. This splint must be worn for seven days.

You may experience mild swelling and discomfort during this time. Dr. Deschamps-Braly will take steps to reduce your pain before the operation. Any pain should be minimal and easily relieved with over-the-counter or non-opioid painkillers. Most swelling usually resolves within 7–10 days.

After one month, you will see the impact of the procedure, with full results apparent by six months after surgery.

Want To Know More?

• Rhinoplasty (Nasal Surgery)
• Revision Rhinoplasty (Corrective Nasal Surgery)
• The Persian “Nose Job”
• The Art Of The Indian Nose Job (Rhinoplasty)

References – For Those Who Like To Dig Deeper

• Dorsal Hump Reduction and Osteotomies. Azizzadeh B and Reilly M. Clinics in Plastic Surgery, 2016; 43, 47–58.