BEFORE AND AFTER
DR. SHAH’S PHILOSOPHY
Dr. Shah’s approach to Dorsal Hump Removal is tailored to each patient. As a leading author of over 50 scientific articles (insert link to Articles Page https://www.shahfacialplastics.com/articles) and an instructor at the University of Chicago, Dr. Shah’s focus is on utilizing scientific approaches to improve your dorsal hump for the best possible outcome, both functionally and aesthetically.
TECHNIQUES FOR NASAL HUMP REMOVAL
Removing the nasal hump can be done in a variety of techniques. In some cases, the nasal hump can be reshaped with rasping or filing of the nasal hump. Dr. Shah recommends the use of a specific set of rasps which allow contouring of the nasal bones in a precise manner. In rare cases, he will use powered instrumentation to remove nasal humps. Other cases require removal of the hump with a sharp cut along the bridge of the nose and bringing in the nasal bones later with osteotomies. In some cases, the nasal hump can be mostly cartilaginous and require reshaping of the cartilage portion.
In rhinoplasty, there are many different ways of performing surgery with sometimes more than one approach being acceptable and creating a beautiful result. This is the challenge for the surgeon to use the best approach and attempt to create it along the nose. Seven of the most common techniques in hump removal of the cartilaginous component are listed below:
TECHNIQUE FOR DORSAL HUMP REMOVAL
TECHNIQUE ONE
Remove Both Upper Lateral Cartilage and Cartilaginous Hum
Solely removing both the upper lateral cartilage and the cartilaginous dorsum is a common technique. This is one of the more common methods of hump removal since it is simple. The technique can be used in patients with small humps and wide internal nasal angles but has a risk of overly narrowing the middle portion of the nasal airway which is sometimes called an Inverted-V Deformity (see below for explanation). Some patients like a narrower nose and can account for this type of hump removal particularly patients with wider noses.
INVERTED V DEFORMITY
The inverted V deformity is where the nasal bones are wider than the upper lateral cartilage. Many patients have a natural wider nasal bones than the upper lateral cartilages, so determination of a true inverted V deformity is subjective. Patients with collapse of the internal nasal valve, where the valve overly moves with inspiration can also have an inverted V deformity. A narrow internal nasal valve is diagnostic (can be measured) but there is some subjectivity to a collapsed internal nasal valve as normal noses will have some movement with deep inspiration.
TECHNIQUE TWO
Remove Just the Cartilaginous Hump and Preserve the Upper Lateral Cartilage
Fig 1. Full ULC
Fig 2. Hump Cut
Fig 3. Preserve
For this technique, the surgeon is going to remove just the nasal hump and preserve the upper lateral cartilage along the edges. This technique is best used for small nasal humps since the amount of removal is limited. This is a highly technical approach which preserves nasal valve function and the length of the upper lateral cartilage and nasal valve.
TECHNIQUE THREE
Suture Back Upper Lateral Cartilages
Here, the surgeon is going to first separate the upper lateral cartilages from the bridge of the nose. The elevated cartilage can now readily be seen and taken down without risk to the upper lateral cartilage. Once the surgeon is satisfied with the bridge appearance. The upper lateral cartilages are simply sutured back in position.
TECHNIQUE FOUR
Separate the Upper Lateral Cartilages and Remove Cartilaginous Hump Then Fold The Upper Lateral Cartilage
Fig 1. Upper Lateral Cartilage is Spread and Hump is Removed
Fig 2. Upper Lateral Cartilage is Folded
Fig 3. Upper Lateral Cartilage is Sutured
After separating the upper lateral cartilages from the bridge of nose, the surgeon will now fold the upper lateral cartilage along the nose, which is called a “spreader flap”. This will put a spring in the middle part of the nose and open up the airway and create width here.
TECHNIQUE FIVE
Separate the Upper Lateral Cartilages and Remove Cartilaginous Hump Then Insert Spreader Graft
Instead of folding the upper lateral cartilages, here the surgeon will use a spreader graft to open up the airway. To find out more about what a spreader graft is, click here.
TECHNIQUE SIX
Separate the Upper Lateral Cartilages and Remove Cartilaginous Hump Then Fold the Upper Lateral Cartilage and Insert Spreader Grafts
Fig 1. ULC is Spread, Hump is Removed and Spreader Graft is Inserted
Fig 2. ULC is Folded
Fig 3. ULC is Sutured
For this technique, a combination of folding the upper lateral cartilages with spreader grafts to create a wider nasal dorsum is used.
The bony removal of the nasal hump which has different techniques for this and methods to account for removal of the bone. Surgeons who perform rhinoplasty for hump removal should have understanding of the anatomy and internal nasal valve. Mention to patients if a surgeon performs surgery without looking in your nose prior that is a red flag even for a solely cosmetic rhinoplasty. Surgeons with both cosmetic and functional training of the nose have an advantage of surgeons with only one of those aspects.
TECHNIQUE SEVEN
Remove the Upper Lateral Cartilage and Cartilage Hump and Replace with Spreader Grafts
Instead of just leaving the patient with missing upper lateral cartilage, here the surgeon will use cartilage to replace the missing tissue. These grafts are placed along the dorsum and can extend all the way into the nasal tip and spread the angle out and are called spreader grafts. These grafts can help with breathing and maintaining stiffness of the upper lateral cartilage and improving opening of the valve.
ALTERNATIVES TO DORSAL HUMP REMOVAL
The alternative to nasal hump removal is the use of nonsurgical rhinoplasty. The main issue with nonsurgical rhinoplasty, however, is that the nose is actually made bigger rather than smaller. Nasal humps are made to look straighter rather than improved. Typically, filler is added to the radix of the nose for best results.
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RECOVERY TIME
Recovery time varies from patient to patient. Most patients are able to return to work at one week. The patient will generally like the appearance of the nose at around one month and the nose will begin to photograph well at around three months. Final healing (including bone portion and bridge of the nose) is around one to two years.
Frequently Asked Questions
Is there a best method of hump removal? Which do I prefer?
They all have their merits and hump removal is based on patient’s anatomy. Surgeons should vary their technique to accommodate their patient’s goals. Consultation is important.
Can you create a perfectly smooth dorsum?
Palpation of the bridge almost always has some little irregularities. Visual appearance is most important of the nose as is function.
Will making my nose wider improve my breathing?
A wider nose does not necessarily breathe better than a narrower one as the nose is extraordinarily complex. There are many parts of the nose which contribute to breathing and the sensation of breathing is highly subjective. How breathing feels to a patient is perhaps the most important.
Can these techniques be used to straighten a crooked bridge?
Yes a combination of these techniques can be used along with others to straighten the nasal bridge.
What are some controversies of nasal hump removal?
A common issue many patients have after a revision or even some primary rhinoplasty is excessive width along the middle portion of the nose. The vast majority of rhinoplasty surgeons will utilize large bulky grafts which may not help all patients functionally or even aesthetically. Dr. Shah has developed a technique to maintain a natural line without creating excessive bulk along the middle portion of the nose.
What Makes Dr. Shah’s Approach To Dorsal Hump Removal Different From Other Surgeons?
Typically, Dr. Shah tries to avoid the use of grafts when possible. Most surgeons resect rather than respect the upper lateral cartilages and then place spreader grafts or don’t place any grafts at all. The main issue is that the nose can either be too narrow with an inverted V or too wide with spreader grafts. The “peel and unpeel” technique removes the cartilage and attempts to replace the upper lateral cartilages back to their original configuration. In some cases, particularly in crooked noses, revision noses, and noses where the upper lateral cartilages are absent or small, grafts are used to improve the function and flow of the nose. Dr. Shah also uses measurements throughout the case to make sure your nose is as precise as possible.
ABOUT US
Dr. Shah is an expert rhinoplasty surgeon in Chicago and a leading authority in removing dorsal humps. His award winning practice focuses on improving the nose and looking natural. His office is located in Downtown Chicago on the historic Miracle Mile of Michigan Avenue. Patients from Illinois, Indiana, and from all around the Midwest and the world seek him out for his natural results which respect nasal anatomy and function.