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What Is Dorsal Hump Removal?

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What is a Nasal Hump?

Nasal humps are also known as the Dorsal Hump. A nasal hump consists of two types of material, either bony hump or cartilaginous to hump. Today we're going to be focusing on the cartilaginous hump. Now the cartilaginous hump is not just cartilage. It's actually composed of septal cartilage and upper lateral cartilage. It's important for surgeons and patients alike to recognize the importance of this cartilage and how it interacts with the body. The upper lateral cartilage and the septum intersect and where they intersect is something called the internal nasal valve. If this valve is too narrow, for some patients, that means that their breathing can be compromised. If this area looks too wide, on the other hand, patients can have aesthetic issues, so surgeons have to balance the aesthetics with the function of the nose when taking down a nasal hump.

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Some patients with a nasal bump may be a result of excessive bone or cartilage. Most nasal humps are made up of a combination of either bone or cartilage. Most nasal humps have a cartilaginous component with amount of bone but all humps vary. The cartilage of the nasal hump consists of the septum connected to the upper lateral cartilages which is often called the cartilaginous pyramid of the nose. Every nose is different and some patients will have longer upper lateral cartilages or smaller ones based on their anatomy. The angle at lower edge of this pyramid is important near the top of this pyramid is important and is called the internal nasal valve. This angle is normally around 10-15 degrees and is where in many people the narrowest part of the airway. We need support along this area or breathing can be compromised. This area can be assessed with direct visual inspection and supporting the nose. In substantial nasal humps, the nose may even require rebuilding of certain components to help maintain symmetry of the nose on the frontal view with the use of spreader grafts.

Dr. Shah’s approach to Dorsal Hump Removal in Chicago, IL is tailored to each patient. As a leading author of over 50 scientific 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

Full ULC

Removing the nasal hump can be done in a variety of techniques.

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

Full ULC

Fig 1. Full ULC

Cut ULC Septum

Fig 2. Cut ULC Septum

Cut ULC Suture

Fig 3. Cut ULC Suture

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

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

Full ULC

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.

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Technique Three Suture Back Upper Lateral Cartilages

Full ULC

Fig 1. Nasal Hump with Upper Lateral Cartilage

Fig 2. Upper Lateral Cartilage is Spread and Hump is Removed

Cut ULC Suture

Fig 3. Upper Lateral Cartilage is Sutured

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 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

Cut ULC Suture

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

Fig 1. Upper Lateral Cartilage is Spread and Hump is Removed

Fig 2. Spreader Graft Is Inserted

Fig 3. Upper Lateral Cartilage is Sutured

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.

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Technique Seven Remove the Upper Lateral Cartilage and Cartilage Hump and Replace with Spreader Grafts

Cut ULC Septum

Fig 1. ULC and Hump are Cut

Fig 2. Spreader Graft is Inserted

Fig 3. ULC is Sutured

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.

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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.

Some quick background: Prior to my revision rhino/septoplasty with Dr. Anil Shah approximately 1 year ago, I had been modeling on a very infrequent level and got booked for only about a photoshoot a month, largely due to the huge amount of time I had to dedicate to contouring my nose before photoshoots and because I couldn't ever take shoots where I'd have to come in with a fresh face (no makeup). Today, I’ve been chosen to represent major brands (including from Microsoft and Mercedes-Benz) and average about 3-4 shoots/week, if not more.

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Testimonial for Best Rhinoplasty Surgeon

Dr. Shah has an extensive knowledge of rhinoplasty. He has written over fifty articles on facial plastics and has written about his technique for finesse rhinoplasty in ‘Masters of Rhinoplasty.’ Dr. Shah is based in Chicago but is sought by patients worldwide. To see more testimonials from his patients, click here

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Recovery Time From Dorsal Hump Removal

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.

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Dorsal Hump Removal FAQ

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Is there a best method of hump removal? Which do I prefer?

They all have their merits and hump removal is based on the patient’s anatomy. Surgeons should vary their techniques 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 that 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 dorsal hump removal office is near me?

If you live near Chicago, IL, Anil Shah Facial Plastic Surgery offers dorsal hump removal among its services and is conveniently located at 200 West Superior St., Suite 200 Chicago, IL 60654.

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.

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