Question: It’s my understanding that a hump on the nose is part bone and part cartilage. So during a nose job, what technique do you use to lessen the bone part and what do you do to lessen the cartilage part?
Answer: Hump reduction, taking down a bump, may seem very simple yet this part of the rhinoplasty where experience, and knowledge of the nasal anatomy is critical for a natural result that won’t compromise your breathing after surgery.
a) Bony part of the hump. This is usually removed with a small chisel either thru a closed or open approach. the rough edges are filed down with a rasp. This will leave an opening in the bridge of the nose, which is why the nose has to be broken, to bring the walls of the nose back together closing the gap created by removing the bony bump. If this is done in a traumatic way, the surgeon can dislocate the upper lateral cartilages, which form part of the cartilaginous bump as well as the main breathing support to the airway, causing collapse of the nose and blockage. In addition if too much of the bony bump is removed, it can create a ski slope appearance. My philosophy is to be conservative, you can always remove a little more but to replace missing bony bridge after over reduction is much more difficult.
b) The cartilage part of bump. this is in the mid portion of the bridge of the nose. The integrity of this cartilage must be maintained. A cartilaginous bump can be reduced without actually removing any of the cartilage. By reshaping it and using the portion that was reshaped as a support mechanism, also called spreader grafts, safe cartilage hump reduction can be performed. This takes more time and skill than just simply removing a piece of the cartilaginous bump.