Background: People consider and undergo rhinoplasty for a variety of nasal shape reasons. But a hump on the bridge of the nose is the number one reason people seek to change the shape of their nose. Whether by intuition or cultural/beauty standards, there is a general desire to have a straight dorsal line of the nose. The bridge of the nose can be high or low but most importantly it must be straight to be aesthetically pleasing.
Many patients are unhappy about the hump on their nose but may otherwise be happy with its shape elsewhere. This understandably makes the patient request only a hump reduction type rhinoplasty. While this may seem to be reasonable it is often not appreciated that changing the shape on one part of the nose can affect how other parts look as well as the overall appearance of the nose.
While it is possible that hump reduction only can make for a better appearing nose, it is equally possible that it will unmask other nasal shape issues. Most commonly when a significant nasal hump is reduced, the nose may actually look longer and the tip may look undesireably downturned. This is why it is critically important before rhinoplasty to have computer imaging done to see how changing one aspect of the nose may affect the appearance of other nasal areas.
Case Study: This 28 year-old female had long been bothered by the bump of her nose. She just wanted it reduced the maximal amount and to almost have a bit of a concavity rather than a straight line. When looking at computer imaging however she realized that she needed the tip of the nose shortened and reduced as well to look right.
Under general anesthesia, she underwent an open rhinoplasty with hump reduction, spreader grafts to the middle vault, caudal septal shortening, and tip shortening and narrowing. When seen fifteen months after surgery she had a much better shaped nose with loss of the hump and a more proportionate tip shape and position. The columellar scar had healed nicely and it was not noticeable.
While hump reduction alone may be an appropriate isolated maneuver in rhinoplasty, one should have a full appreciation before surgery as to how that alone may affect the look of the nose. More times than not the decision to do more than just a hump reduction rhinoplasty alone will be made.
Highlights:
1) The reduction of hump or bump on the bridge of the nose is one of the most common reasons people undergo rhinoplasty surgery.
2) Reduction of a nasal hump may or may not be able to be done by itself but should first be determined before surgery by computer imaging.
3) Hump reduction often requires other nasal modifications, particularly in the tip, to give the best aesthetic nasal shape from a rhinoplasty.
Dr. Barry Eppley
Indianapolis, Indiana