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PROFILES Modern Rhinoplasty Textbook

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The Nasal Hump

Written by Dr. Litner and Dr. Solieman

Sometimes described as hooked or Roman, a nose with a pronounced bump on the bridge can distract from other facial features. For those with prominent bumps, the reduction or excision of the bump – or dorsal nasal hump – is an integral part of the rhinoplasty procedure.

Causes of a Nasal Hump

Often the development of a nasal hump is genetically influenced. A prominent nasal hump is commonly inherited as a family trait. However, trauma to the nose, such as a fracture, can also play a role in the appearance of a prominent nasal hump. In some cases an earlier childhood injury may begin to manifest itself as the nose enters a second growth spurt during adolescence.

Composition of a Nasal Hump

The upper third of the nasal bridge consists of bone and the lower two-thirds are composed of cartilage. Although a nasal hump may be limited to either the bony part or the cartilaginous area, in most cases, a nasal hump is formed from an excess of both bone and cartilage. Usually, much of the nasal hump is located in what is referred to as the cartilaginous vault, the area of the nose that includes the upper lateral cartilages and the nasal septum. Because the upper lateral cartilages and nasal septum are adjoining, an injury to one will usually affect the other.

Evaluation and Treatment

During a surgical evaluation, a thorough medical history is taken, including an examination of the airways and any obstructions. If the patient has had previous nose surgery or nasal trauma, the specific circumstances will be reviewed as part of the assessment. In the case of a known accident, photographs that show the patient’s nose prior to injury may prove to be helpful in guiding treatment.

The nasal bones will be assessed in terms of size, shape, thickness, and symmetry. The composition of the nasal hump (the proportion of bone to cartilage) will be ascertained and, additionally, an examination of the nose’s interior will be performed to determine if septal deviation or other irregularities are affecting the nasal passages. The quality and thickness of the overlying skin will also be considered to gain insight into how the overlying skin and soft tissue will wrap to the nose one the nasal hump has been reduced.

Female face, before external nasal valve treatment, front viewFemale face, after external nasal valve treatment, front viewBeforeAfter
Female face, before external nasal valve treatment, right side viewFemale face, after external nasal valve treatment, right side viewBeforeAfter

Aesthetically, the appearance of the nasal hump will be evaluated in profile, as well as in relation to the frontal view and the projection of the nasal tip. The goal is to achieve a balanced outcome from all angles.

Surgical Techniques

In order to eliminate a nasal hump, the removal of both bone and cartilage is generally required. During the procedure, incisions are made so that the skin can be elevated to expose the cartilage and bone. Unlike other surgeons, who occasionally will reduce a hump by fracturing off the unwanted portion with a cutting instrument, Drs. Solieman and Litner take painstaking care to slowly “sandpaper” the hump down in order to better control the procedure. This allows for creation of a smooth, natural, three-dimensional contour reduction without irregularities. They then utilize controlled fracture techniques in order to maximize the likelihood of consistent, reliable results with minimal bruising and swelling.


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