Dorsal Hump

A hump or bump on the bridge of the nose is probably the most common feature altered with rhinoplasty. The hump may be a familial trait or caused by trauma. Even as we age, it seems like we ‘grow’ a hump due to loss of nasal tip support. This is such a common phenomenon that we often associate a hump with an aged appearance. As a result, removing a hump will often make one appear younger. 

How Can It Be Fixed?

The skill in hump removal is making sure the bone and cartilage blend into one another so that the bridge looks smooth from top to bottom. During surgery, the bone and cartilage of the hump are carefully removed.  After the hump is removed, the sides of the nose are pushed inward to narrow the new bridge in a finessed and controlled manner. Finally, the width of the nasal valve area is checked. A narrow nasal valve not only makes breathing more difficult, it may create a visible indentation that looks like an upside-down ‘V’. If narrow, the nasal valve area is widened with cartilage grafts from the nasal septum, creating a smooth flow from the top to bottom of the nose.

Low Bridge/Saddle Nose

The opposite of a hump on the bridge is a low bridge, also known as a saddle nose. A saddle nose has a bridge that appears low or indented on profile and wide and undefined from the front due to insufficient cartilage and bone. It may be congenital, an ethnic variation, or occur as a result of trauma or previous surgery in which the bridge was reduced too much. 

How Can It Be Fixed?

To add structure to the bridge, cartilage grafts are placed to widen the nasal valve area. The cartilage grafts that are used must be strong. For this reason, we prefer rib cartilage. Not only is it firm, but it may also be sculpted to resemble normal structure (e.g. the nasal bridge).Another option is to use donor rib cartilage from the deceased who have donated their bodies for medical use. The donor's rib has been treated to remove all microbes and cells. Once the treated rib cartilage is put into your nose, your own cells occupy it and it becomes a part of you. 

Crooked Nose

A crooked nose may be quite noticeable and impede breathing or prevent you from wearing eyeglasses correctly. Trauma is often the cause of a crooked nose, though it is possible to have one since birth. Deviations in the nasal septum or nasal bones often cause the entire nose to bend to one side. These bends can affect breathing by blocking airflow, especially at the nasal valve region. They may also block sinus drainage. The nose may bend to one side only or in multiple directions creating a C- or S-shaped nose. 

How Can It Be Fixed?

During surgery, the structures of the nose are "released" from one another to reduce tension. Cartilage that is bent or deviated has “memory” and resists straightening. Methods of scoring, shaving, flattening, splinting, or removing cartilage is necessary to cause bends to unbend. The key is to strengthen, not weaken, structural supports for the nose – otherwise, the nose may collapse over time. The nasal bones often need to be re-positioned into a straighter, more symmetric position. Cartilage grafts from the nasal septum are often used to splint and straighten the bridge of the nose. The released structures are put back together in a more symmetric fashion. 

Pinched Nose

A pinched nose appears too narrow and may compromise breathing. Unfortunately, this may be a by-product of previous aggressive rhinoplasty. A nose that is narrow may make the face appear wider or make the eyes appear widely set. Narrowness solely in the tip and nostrils may make the bridge look too wide, and vice versa. The goal is to make the nose more balanced top to bottom and better proportioned to the size of the face. 

 The pinched portion may be at the nasal valve region, located just below the bony bridge, and may appear as an upside-down ‘V’. Another site of pinching may be at the nostrils and/or nasal tip. This may appear as a deepening of the crease above the nostril and lead to airway collapse with forceful inspiration. A weak nostril rim may also contribute to airway collapse.  

How Can It Be Fixed?

The goal of correction is to strengthen the nose and re-create structure. In the case of a narrow nasal valve, cartilage grafts are placed to widen this region. When the nostrils and nasal tip are pinched, cartilage grafts are used to fill-in the contour from the nasal tip to the nostril crease. For a weak nostril rim, a cartilage graft is precisely placed directly into the rim to add strength and support.