What is Dorsal Hump Reduction?

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Dorsal hump reduction is just about reducing the bump on the nose as seen from the profile of the face. Not all humps are the same. Some dorsal humps are large, some are small. In addition, every patient will have different desires about the results they would like to achieve. With a consultation analysis, patients come to the office and it is very important to spend time analyzing the physical anatomy of the nose. However, most importantly, to spend time with the patient and know what their wants and desires are and discuss what is possible for them.

 

Computer imaging is a useful tool for patients for them to foresee what the nose may look like in proportion to the face after the surgery is completed. Sometimes with a dorsal hump reduction, there will be a modification of the tip of the nose to keep the proportions in balance. Also, it is worthy to note that computer simulations are not guaranteed results. The simulations are not a marketing tool, they are a communication tool. It is really meant for the doctor and the patient to understand each other in terms of what the goals are for the plastic surgery. It is very important to use this very carefully because obviously, it is very powerful to see these images.

If you look back on all the before and afters of plastic surgery patients, none of them will look exactly like the simulations. They will look pretty close, however. It just gives a good idea of what we would like to achieve in the operating room for the surgery.

What is the surgery like?

It is a light general anaesthesia that provides a very rapid recovery. It is an outpatient surgery, with around two to three hours to complete the procedure. Patients are able to go home the same day. The surgery may be a little bit shorter or a little bit longer, but will generally fall under these guidelines. In the operating room, surgeons want to leave their patients with the most aesthetically pleasing after look. This means usually there is a small incision underneath the tip of the nose that can easily be hidden after the surgery. In the surgical procedure, once the area is exposed, we can see the cartilage and the bones.

Step one is to release the upper lateral cartilages using a specialized tool inside of the nose. Second is to reduce the bone portion of the dorsal hump, which often leads to a big change in the nose’s structure. Once this is done with a sharp chisel, everything is exposed and ready for the next step. In the next step, using the computer images which we used previously, exact measurements are taken with these photos and used in the operating room. This way we know exactly how much septum to reduce to get the dorsal profile that we want.

There will also be an area of bone now missing that will look a little bit flat. This is called an open roof and we will do something to fix that. Once the septum is reduced, we then perform a reconstruction of the mid-vault. This is also done carefully with a specialized tool. With this technique, the upper lateral cartilage is scored slightly and then actually turned in to reconstruct the mid vault area and keep it from collapsing. This allows the airway to be maintained.

Close the Roof

Once this is all done, more surgery will be performed to close the open roof. There are cuts in the bone laterally. This allows us to move the bones together and create a nice profile in the frontal and side view.

What About the Tip?

Often when we perform dorsal hump reductions, we will do something to make the tip a little bit smaller and maybe rotate it up. The reasons for this are that we have made the upper vault of the nose a little bit narrower, and the tip may actually look wider even though it is not wider after the surgery. In addition, the nose can look a little bit longer after we take out the dorsal hump, so often we rotate the tip up a little bit.

Finishing Touches

After we have done our dorsal hump reduction and the skeleton looks great and the tip is in the right position, one last look is necessary to make sure everything looks really good. One of the things we do in this step is to examine and feel the profile of the nose with our finger and make sure the bone can camouflage nicely into the profile.

Finally, after all this is done and we have sutured it back together, a small amount of tape is placed on the nose and then a nasal splint is applied. The purpose of this is to protect the nose and to reduce the swelling that may occur in the first week.

What is the Recovery Like?

Usually, there is a splint on the nose for six to eight days and the stitches come out after that. There can be mild to moderate bruising. The patient can shower but if possible must try to keep the nose dry. There should be no strenuous exercise for three weeks, which may be a challenge for athletic patients to adhere to. There also must be no contact sports for six weeks after the surgery.

 

One thing that patients will notice is that the tip of the nose will feel a little bit stiffer and feel numb for a few weeks to months afterwards. This typically resolves itself, but final results take a full year.

Dr Daniel Becker is a board-certified plastic surgeon who specializes in rhinoplasty procedures in Philadelphia and New Jersey areas. To schedule a consultation, call Dr Becker’s office at 609-436-5740 or visit www.therhinoplastycenter.com for more information.


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