Dorsal hump removal without surgery
Dorsal reductions with / without infractures
If you have small dorsal hump, a slight (1-2mm) reduction can generally be performed without needing in-fractures.
If you have a significant dorsal hump, in-fractures are needed for 2 reasons: Open Roof Deformity – quite well explained by Dr. Aldea (Too) wide dorsum
Think of your nasal bones as the Pyramids in Egypt. If you decided to remove the top 1/2 of the pyramid and then viewed it from above, the tip would no longer be a sharp point, but rather a wide and flat level region.
If you viewed the pyramid from the side and pushed the walls in (keeping the same angles), you could again achieve a narrow tip.
The ostoeotomies are done to disconnect the nasal bones from the maxilla (releasing the pyramid walls from the ground), so they can be pushed together and narrow the nose.
I hope these analogies help with understanding the necessity of “breaking” the nose in certain cases. (Michael A. Bogdan, MD, FACS, Dallas Plastic Surgeon)
Flat nasal bridge after smoothing hump
Depending on the extent of filing, you could end up with a flattened surface along the top of your nose. If you only have a little flattening done you might be able to get away without osteotomies, but you would likely not have the degree or improvement you would like either.
With more flattening you really do need to move the bones inward to recreate a nice rounded dorsum.
Dorsal hump removal without surgery possible
It is typical to need to do this with most rhinoplasty and the only times I have seen someone who didn’t have it done it doesn’t look very good. (Robert B. Pollack, MD, La Jolla Plastic Surgeon)
Don’t set restrictions on your Rhinoplasty surgeon
A rhinoplasty is a complex operation even for me with 35 years of experience doing them. Don’t restrict your surgeon – if an osteotomy is needed let it be done. You won’t feel it or even know it was done. If you have a good tip, maybe nothing will need to be done. Speak to an expert – we have a lot of experience and can guide you in how to deal with your problem. (William B. Rosenblatt, MD, New York Plastic Surgeon)
The open roof deformity
Dorsal bump removal without surgery image before
When removing a large dorsal hump (not overdoing it either) there will be a flattness of the dorsum called an “open roof deformity.” It is to correct this that infracturing is done. It doesn’t add anything to the recovery other than a little more bruising under the eyes so it is nothing to be afraid of. Patients should tell their surgeons what bothers them and then let the surgeon do what they need to do to correct it. In most large dorsal humps, this would include infracturing. (Richard P. Rand, MD, FACS, Seattle Plastic Surgeon)
Can a Large Nasal Dorsal hump be “filed down” WITHOUT having to break the Nose?
Dorsal hump removal without surgery picture
The appearance of the nose depends on the ability of the covering skin to drape properly on top of it. When a large nose hump is filed down, it literally looks like a rowing boat, flipped over whose bottom had been sawed off and covered with a light cloth – in other words – flat bottomed.
The ONLY way to restore the narrow look of the nasal dorsum is to break the sides of the cheek bones meeting the nose and push them together – this is called osteotomies. While a small hump MAY be able to be reduced without side fractures, a large ethnic hump cannot be reduced and a nice result achieved without nasal fractures. (The exception is a SKOOG Procedure which involves replacing a less prominent piece of the hump back as a graft). (Peter A. Aldea, MD, Memphis Plastic Surgeon)