A dorsal hump or “hump” as patients commonly refer to it, is a convex shape to the bridge of the nose. The hump, by deviating from the classic straight bridge profile, draws attention to the nose. Thus, even if a nose is otherwise small (as far as length or tip size) it still seems large and out of proportion. In women, a prominent hump can be masculinizing and especially bothersome to the patient.

Throughout the years, many surgeons have shown that the bony pyramid can be reliably reduced, repositioned, or augmented through an endonasal approach. However, open rhinoplasty may allow more precise contour refining of the nasal dorsum. The incidence of profile irregularities may be reduced when procedures are performed via the open approach. The benefits of increased exposure to the dorsum, available with the open rhinoplasty approach, should be exploited whenever possible.

There is a tendency of some surgeons to treat the bony pyramid in an essentially closed fashion, even when using the open approach. A closed approach has been reliable for addressing most bony profile problems. However, when performing an open rhinoplasty. With this open approach to the nasal dorsum and because of technical differences relating to the skin positioning, the rhinoplasty surgeon may require a different (i.e., narrower) osteotome from that which was previously used for “closed” hump reduction.

An 8-mm unguarded osteotome is preferable for most bony hump reductions when using an open approach (Figs. 1 and 2). Significantly wider osteotomes may be too wide and can cause injury to the skin–soft tissue envelope when using an open approach.

When the “closed” approach is used, the skin–soft tissue envelope is redraped into anatomic position before the hump excision, and awider osteotome can be accommodated. However, this additional width is not necessary for an open approach. The osteotome needs to be only as wide as the widest point of the hump resection, typically at the rhinion. When using an osteotome for dorsal hump excision under direct visualization, the 8-mm nonguarded osteotome provides a sharp cutting surface and precise size for this procedure. At times-when the patient has a very large hump -a wider osteotome may be preferable. This approach has been especially useful in revision patients where underresection or asymmetric resection has occurred. The direct visualization afforded by this approach allows for more precision in these difficult revision situations.

Q:Is Nasal Hump Reduction a Simple Procedure?

A: Obviously, any type of nasal cosmetic rhinoplasty is not a “simple” operative procedure. Even reducing a nasal hump takes significant operative skills since it is a surgical procedure of millimeters. The goal is to reshape the dorsum to make it harmonious with the face and have a smooth dorsum as it transcends into the tip without any irregularities. There is no such thing as a simple nasal reduction or a simple rhinoplasty.

Q: Will the result looks natural?

A: It’s definitely possible for you to have a natural look. We would recommend you see an experienced rhinoplasty surgeon for consultation and discuss with him/her what you would like your nose to look like. Sometimes bringing photos of noses you like helps and many surgeons have computer programs that do recreations of what your nose may look like. Regardless, good communication with your surgeon is critical. He/she will be able to help you set realistic expectations on what your nose can look like based on your personal anatomy.