Dorsal Hump

What a dorsal hump is made of

The bridge is not one structure. Its upper third is bone. Below that the framework is cartilage, and the two meet part way down the profile.

• The bony vault. The paired nasal bones, sitting nearer the eyes.
• The cartilaginous vault. The dorsal septum in the middle, with an upper lateral cartilage on each side.
• The skin over both. Not part of the framework, and not changed by reshaping it.

Which part dominates changes what the operation involves, and a surgeon should be able to point to it on your own photographs.

The profile reads as one line from the radix, the root of the nose between the eyes, to the tip. What looks like too much bridge is sometimes too little elsewhere.

When a hump appeared, and why that matters

The useful question is when the hump appeared. One present since the nose finished growing is a different starting point from one that followed a blow to the nose.

The nasal skeleton is generally considered developed from around age 15 in females and 17 in males, and surgery is usually performed once it has.

Nothing applied to the outside changes the framework beneath. Bone and cartilage are altered by surgery, and skin thickness is set by the anatomy you already have.

A hump with an injury behind it may come with a bend, a blocked side, or both, so the assessment covers the airway as well as the profile.

What lowering a hump actually involves

Taking the top off the bony and cartilaginous vault leaves the side walls standing apart. That is the open roof, and it has to be closed again.

As the bridge is reduced, the middle third has to be rebuilt. If it is not, the cartilages can drop away and leave a visible inverted V.

Controlled cuts in the bone, called osteotomies, bring the walls back together. That is why a hump reduction is rarely only a reduction, and why a plan described as filing alone is worth a question.

What it does not change

• The thickness of the skin over the bridge, which is what conceals fine work on the framework beneath.
• A nose that sits off centre, which is usually off centre because the septum is bent.
• Blocked breathing. Reshaping the outside alone does not correct a deviated septum or a weak nasal valve.

The technique names you will be offered

Three names come up in most hump quotes. They describe how the work is done, not what the result will be.

• Ultrasonic rhinoplasty shapes bone with a piezoelectric handpiece rather than a chisel. What the pooled trials measured is set out on that page.
• Preservation rhinoplasty lowers the existing dorsal line from beneath instead of removing the roof and rebuilding it. Its comparative evidence is thin.
• Open rhinoplasty is a route in rather than a technique for the hump. It adds a short incision across the columella and exposes the framework.

A scar across the columella, the strip of skin between the nostrils, is the cost of that exposure. An approach that keeps every incision inside the nostrils avoids it.

None of the three is a result. The choice follows the anatomy, and the same hump can reasonably be approached in more than one way.

What the profile looks like afterwards, and when

The profile on the day the splint comes off is not the result. Swelling is at its highest in the first fortnight, roughly when the splint is removed.

A settled result is commonly quoted at 12 to 18 months. It takes longer with thick skin, and longer again after revision surgery. The tip settles last.

Judging a profile in the first weeks judges swelling, not shape. A photograph taken before you fly home shows an early stage. The recovery timeline sets out each stage.