Dorsal Hump Rhinoplasty Philadelphia, PA | Nose Surgery by Dr. Anthony Corrado

THE NASAL DORSUM

(BRIDGE OF THE NOSE)

The nasal dorsum, otherwise known as “the bridge” of the nose, makes up the upper 2/3 of the nose. The upper half of the nasal dorsum is made up of the nasal bones. The nasal bones are paired structures that come together to form the bony nasal vault. The lower half of the nasal dorsum is cartilaginous, consisting of the dorsal septum and upper lateral cartilage.

THE DORSAL HUMP

Excessive dorsal convexity, dorsal height, or fullness of “the bridge” can lead to the appearance of a dorsal hump. A dorsal hump refers to the appearance of a bump on “the bridge”. A dorsal hump can significantly detract from the appearance of the nose, specifically when evaluating one’s profile. A dorsal hump can be composed of bone, cartilage, or a combination of both.

Treatment of a dorsal hump involves the removal of excessive bone or cartilage to reduce the dorsal height and create a smooth appearance to “the bridge” to improve the nasal profile. Nasal profile appearance is typically based on patient preference which is discussed with patients prior to surgery.

Before and After

A straight dorsal contour is typically desired by most male patients, while females typically request a straight or slightly concave contour. An overly aggressive hump reduction leading to a “scooped” or “ski slope” type appearance can cause the nose to appear very unnatural and “overdone”. While this type of look was popular in the past, it is typically frowned upon by the modern rhinoplasty surgeon.

The bony and cartilaginous components in dorsal hump reduction are addressed separately. The bony hump is typically “filed down” with specialized surgical files, otherwise known as nasal rasps. The cartilaginous hump is usually reduced with special dorsal scissors or meticulously shaved with a scalpel blade. Following large dorsal hump removal, an “open roof” deformity is typically present which will need to be addressed.

Before After

These patients underwent rhinoplasty for dorsal hump reduction to improve their profile. Note the resulting smooth character of the nasal dorsum after surgery.

Before and After Infographic

Anatomic representation of a dorsal hump and the resulting smooth dorsum after hump reduction. The upper portion of the dorsal hump is composed of bone and the lower portion is composed of cartilage.

Hump reduction:

THERE ARE SOME FACTORS WHICH MUST BE CONSIDERED BEFORE PERFORMING A HUMP REDUCTION.

Is the hump due to excess bone, cartilage or both? The upper third of the bridge is comprised of bone, while the lower two thirds is cartilage. If the hump is present in the upper portion of the bridge, bone removal will be performed with special surgical files, called rasps. If the hump is located in the lower area of the bridge and is a result of excess cartilage only, the cartilage can be delicately trimmed with special scissors or scalpel blade. Most patients have a combination of both excess bone and cartilage which requires a combination of the two approaches mentioned.
How much reduction does a patient want? This is a very important conversation that must take place between the facial plastic surgeon and patient. It ultimately comes down to personal preference. Some patients want a dramatic improvement, while others want a conservative result. Digital morphing can be used to demonstrate how a person may look with varying degrees of hump removal.
Is a radix graft needed? During the evaluation, Dr. Corrado will assess your nose to determine if you have a pseudo-hump deformity. This is when the upper portion of the bridge (radix) is underdeveloped. This leads to the nose looking fuller from the profile view below the radix. A radix graft will create better balance.
Are spreader grafts needed to prevent future complications? If an individual has pre-existing middle vault narrowing or collapse, grafts will be needed to provide the necessary support to the upper lateral cartilages. For those without this issue, the need for spreader grafts will depend on how much of the hump is going to removed, with typically larger hump reductions requiring the placement of spreader grafts to prevent future issues. As the nose skin and soft tissues shrink after hump reduction, scar contracture occurs which can lead to middle third collapse or narrowing in the future. This can lead to breathing and aesthetic issues. The spreader grafts provide the support needed to prevent this potential complication.

STEPS TO PERFORMING CLASSIC HUMP REDUCTION

It takes more than just simply taking down the hump on the nose to properly perform a hump reduction.

The steps Dr. Corrado takes when performing classic hump reduction include:

Reduce the size of the hump.
Perform osteotomies to reposition the nasal bones to close the “open roof” which results after hump reduction.
Possibly place a radix graft and/or spreader grafts depending on the specific case.
Re-align the tip projection and rotation to look good with new bridge height.

Dorsal Hump Reduction Rhinoplasty