Background: Rhinoplasty is one of the most common facial plastic surgery procedures performed. It is also the dominant facial reshaping procedure that has been performed for over a century. Historically and up to the present day removal of a hump or a lowering of the bridge of the nose is one of the most common patient requests for the procedure.
A straight line of the nose in profile, also known as a straight dorsal line, is a desired aesthetic feature of a nose. The major portion of the dorsal line is in the upper half of the nose and is comprised of the union of the lower edges of the paired nasal bones and the septum and upper end of the paired upper lateral cartilages. When the septum overgrows underneath the union of the nasal bones and upper lateral cartilages raises up creating varying degrees of a prominent nasal hump.
Reduction of a prominent nasal hump is one of the most commonly understood techniques in rhinoplasty. By removing the high portions of the nasal septum and the ends of the nasal bones, a flat plateau is created. Re-establishment of a narrow roof or dorsal line is created by collapsing the nasal bones inward. This is done by the classic cutting or breaking of the nasal bones at different levels so that they move inward.
Case Study: This 26 year female had always disliked her nose with the most dissatisfied area being that of the prominent hump. She also did not like the tip of her nose which she felt was thick and bulbous. Computer imaging done before surgery showed what type of result was realistically possible. Her request was to have a dorsal line that was a but dipped as opposed to a perfectly straight dorsal line.
Under general anesthesia and through an open rhinoplasty, her nasal hump through septal cartilage and nasal bone removal was done. Medial and low lateral osteotomies were done to close the open roof which were also rasped smooth. Her septum was straightened and a grafts harvested and used as spreader grafts between the septum and the upper lateral cartilages. The tip cartilages were reduced/shortened and reshaped for a more narrow and uplifted tip.
The success of many rhinoplasty surgeries hinges on how well a nasal hump is reduced. At the least most patients want a straight dorsal line with no evidence of any residual hump. Men almost always prefer a high straight dorsal line while some women want may want a slight concavity to it. With dorsal hump reduction the nasal tip becomes even more prominent and often needs to be reduced and reshaped as well.
Highlights:
- One of the most common requests by patients considering rhinoplasty is removal of a prominent hump on the bridge of the nose.
- Hump reduction in a rhinoplasty is a combination of bone and cartilage reduction.
- While many patients think that all they need is a reduction of the hump, rarely would this be the only maneuver needed in their rhinoplasty.
Dr. Barry Eppley
Indianapolis, Indiana