Your Questions

Q: Dr. Eppley, I am interested in getting my nose done. My main reason is that I don’t like this bump on my nose. The rest of my nose I am really fine with. What I want to know is how can this bump be taken down. Can it be shaved or does it have be cut off? Will I need to have my nose broken? What type of rhinoplasty needs to be done? Will this in any way affect my breathing?

A:  A bump or hump on the nose is one of the most common reasons one seeks a rhinoplasty procedure. Reducing a hump and having a smoother bridge of the nose makes it appear more pleasing.  A hump on the nose is not just bone but a combination of bone and cartilage most of the time. Very small bumps may be bone only but the midportion of larger humps, known as the rhinion, is at the junction of bone and cartilage. Reducing the nasal hump, therefore, must take down bone and cartilage in the vast majority of cases.

If a patient only needs a hump to be taken down for their rhinoplasty, I will do it through what is known as a closed approach. (incisions on the inside of the nose only) Most rhinoplasties, however, involve hump and other changes as well so an open approach with degloving of the nasal skin provides a much better view and more predictable results.

Breaking of the nasal bones is often a part of hump reduction but frequently not understood. When large humps of the nose are taken down, removal of that hump or ‘roofline’ (bone and cartilage) leaves a flat and open bridge area. The nasal bones are no longer attached to the apex of the roofline but are standing ‘open’. This is one reason why the nasal bones are broken (nasal osteotomies) so that they will fall back in towards the center, recreating the roofline and making the bridge of the nose smooth and more rounded. This may also make the upper part of the nose more narrow which is often desireable.

Small hump reductions do not require breaking the bones of the nose, but larger hump reductions almost always do. That is why some patients will get black and blue under the eyes after rhinoplasty while others do not.

The trend today, not only for aesthetic reasons but to preserve good breathing through the nose, is to keep a high dorsal nasal profile. Taking down the bridge of the nose too much, as was commonly done in the past with ‘scooped out’ or ‘ski-jump’ noses, is not acceptable today as it leads to breathing problems. Keep a high but smooth dorsal line helps not only to protect breathing through the nose but to prevent further collapse (known as a saddle nose deformity) later in life.

Dr. Barry Eppley

Indianapolis Indiana

A bump or hump on the nose is one of the most common reasons someone doesn’t like the way their nose looks. Removing a hump on the nose and having a smoother bridge down its length will make it appear more pleasing.  That feeling about a nose hump is universal as people seem to intuitively know when the upper part of the nose is out of balance to the lower part of the nose…humps make the nose look too big and thick and sometimes even ages a face. Large nose humps can make one look older. (just like a downturned tip of the nose)

Hump reduction of the nose is one of the main reasons many people want nose-changing surgery or rhinoplasty. But removing a nasal hump is usually more than just simple shaving of the bone. What makes up most humps is a combination of bone and cartilage as the hump occurs where the bone of the nose stops and the cartilage of the nose begins. This means that both bone and cartilage must be taken down for a successful hump removal.

How big a nose hump is changes how it is done and what the recovery would be. Small hump reductions can be done by shaving or rasping and do not require breaking the bones of the nose, but larger hump reductions almost always do. That is why some patients will get black and blue under the eyes after a rhinoplasty while others do not.

Think of the bridge of the nose like the roof line on your house. Trimming off a little bit of the rooftop will not significantly change the inverted-V shape of the roof. (small hump) But taking more than just the very top of the roof line will leave the sides of the roof standing where they originally were….with an open top. To change that open roof back to an inverted-V shape requires moving the sides of the roof inward. To make them fall back to the middle, the base of the roof must be cut so they will fall back in together. This is what breaking or cutting the nose bones does. It is also the rhinoplasty maneuver that will leave you with black eyes afterward. The nasal bones are cut down low and then pushed in to close the open roof. This will also make the upper part of the nose more narrow and less thick.

Taking off a nasal hump, however, must not be done too far. Taking down the bridge of the nose too much, as was commonly done in the past, results in ‘scooped out’ or ‘ski-jump’ noses and leads to breathing problems. Keep a high but smooth and non-humped bridge of the nose helps to protect from breathing problems after rhinoplasty surgery.

Interestingly, taking down a hump also makes the nose look smaller and less long, an optical illusion that can easily be demonstrated by computer imaging.

The shape of one’s nose is said to reflect on one’s personality. I have no idea whether that is true but a well-shaped nose without a hump can definitely improve one’s facial balance and appearance.

Dr. Barry Eppley

Indianapolis Indiana