rhinoplasty.cc
Menu

Surgery

Dorsal hump reduction

The hump on a profile is not one thing: it is bone at the top, cartilage below it, and the joint where they meet. Taking it off in one pass with a rasp or an osteotome removes the roof of the middle third and, months later, leaves a shadow across the bridge and a narrower airway. The component technique takes it down in five graded steps instead, protecting the upper lateral cartilages and the paired lines that define the nose from the front.

What the operation has to protect

Four things that decide whether a hump reduction holds.

The dorsal aesthetic lines, which are what people actually see

From the front the nose reads as two slightly curved highlight lines running from the inner brows to the tip. A profile can be made straight and those lines still be wrong, irregular, too narrow, or interrupted where the bones end. The component technique is written around them: protect and form strong dorsal aesthetic lines, because they define the dorsum on frontal view.

Rests on: Rohrich et al., component dorsal hump reduction.

The internal valve, which is directly under the hump

The transverse portions of the upper lateral cartilages hold the angle between cartilage and septum open. Detaching them and removing the dorsum without rebuilding narrows that angle, which is why a purely cosmetic hump reduction can leave a patient breathing worse. Preserving them is stated in the original paper as essential to keeping the valve patent.

Rests on: Rohrich et al. · and the septum and the airway.

The roof, once opened, has to be closed

Removing an osseocartilaginous hump leaves an open roof between the nasal bones and separates the upper laterals from the septum. Left alone it becomes a flat, wide bridge and, later, the inverted-V deformity. The structural answer is spreader grafts or the upper lateral cartilage folded inward as an autospreader, placed prophylactically in cosmetic primaries, they held nasal width at one year (a 1 mm increase that was not significant) while preserving breathing scores.

Rests on: Sheen, the spreader graft · Jabbour et al., prophylactic autospreader flaps.

The alternative is not to open it at all

Dorsal preservation lowers the intact roof from underneath instead of removing it. Head to head in randomised trials it comes out ahead on patient-reported scores at six months and level by twelve, with its own distinctive failure, the hump returning. The choice between them is made on the anatomy: hump size, bone shape, deviation, and how much dorsal modification the nose needs.

Rests on: Shim et al., four randomised trials · and preservation rhinoplasty.

The five steps, and what each one is for

The component technique as published, in order.

1. Separate the upper lateral cartilages from the septum

Done first and deliberately, so the cartilaginous and bony parts of the hump can be reduced independently rather than shaved off together. This is the step that makes everything after it incremental.

2. Reduce the septum incrementally

The dorsal septum is lowered a little at a time, checking the profile as it goes. Most humps are more cartilage than bone, and this is where the profile is actually set.

3. Reduce the bone

Rasp, osteotome, piezoelectric tip or powered burr. Bone thickness is not uniform, thickest at the middle of the lateral osteotomy path, thicker in men, and thicker on the deviated side of an asymmetric vault, which a third of patients have. Ultrasonic cutting is the best-evidenced instrument change in this literature: less swelling, less bruising, less pain and no mucosal injury across 19 randomised trials and 905 patients.

Rests on: Kim et al., the bony vault · Armanfar et al., piezoelectric against conventional.

4. Verify by palpation

The surgeon feels the dorsum rather than trusting the view, because a small residual edge is invisible under a swollen envelope and obvious a year later in thin skin.

5. Finish: spreader grafts, sutures, osteotomies

Rebuild the middle vault if the roof was opened, narrow the bones with osteotomies, and set the final lines. The paper's claim is that steps 1 to 4 done properly reduce how often step 5 needs spreader grafts in a primary nose.

Rests on: Rohrich et al. · and the dorsum and the hump.

What goes wrong when it is done badly

The named sequelae, each with the paper that describes it.

Dorsal irregularity

Uneven resection, over-resection or under-resection leaves a step, a ridge or a residual hump that becomes visible as swelling resolves, most often in thin skin, and often not until a year out.

Rests on: Rohrich et al..

Inverted-V deformity

The unsupported upper lateral cartilages collapse inward below the ends of the nasal bones, casting a V-shaped shadow across the middle third. The commonest late reason for a revision after hump reduction, and the reason spreader grafts exist.

Rests on: Rohrich et al. · Sheen · and revision rhinoplasty.

An open roof and a wide, flat bridge

The gap between the nasal bones was never closed with osteotomies. Corrected by doing them, or camouflaged with an onlay graft.

A narrowed airway

The middle vault was narrowed without support, so the internal valve angle closed. This is why breathing is asked about before a cosmetic hump reduction, not after it.

Rests on: Rohrich et al. · and the septum and the airway.

Pollybeak

The cartilaginous dorsum was left too high relative to the tip, or scar filled the space above it, so the profile beaks. Prevented by reducing the septum incrementally and supporting the tip; treated early with steroid injection, late with surgery.

Rests on: Khan et al., triamcinolone injections · and nasal tip.

Frequently asked questions

The questions people search, answered from the technique papers.

How is a nose hump removed?

In graded steps rather than one pass. Taking the hump off with a single sweep of a rasp or an osteotome removes the roof of the middle third and, months later, leaves a shadow across the bridge and a narrower airway. The component technique takes it down in five steps, protecting the upper lateral cartilages and the two highlight lines that define the nose from the front.

Rests on: Rohrich et al., component dorsal hump reduction.

Are the bones broken?

Usually. Osteotomies narrow or straighten the bony vault after the hump comes off, and the bone is not uniform: it is thickest at the middle of the lateral osteotomy path, thicker in men, and thicker on the deviated side of an asymmetric vault.

Rests on: the osteotomy section.

Why does a hump reduction sometimes make breathing worse?

The internal valve sits directly under the hump. The transverse portions of the upper lateral cartilages hold the angle between cartilage and septum open, so detaching them and removing the dorsum without rebuilding narrows that angle.

Rests on: Rohrich et al. · the septum and the airway.

What is an inverted-V deformity?

A visible step where the nasal bones end. Removing an osseocartilaginous hump leaves an open roof and separates the upper lateral cartilages from the septum. Left alone it becomes a flat, wide bridge and later a visible V. Spreader grafts, or the upper lateral cartilage folded inward as an autospreader, close it.

Rests on: Sheen, the spreader graft · Jabbour et al., prophylactic autospreader flaps.

Is there a way to avoid opening the roof at all?

Yes. Dorsal preservation lowers the intact roof instead of cutting it off, so the middle vault never has to be rebuilt.

Rests on: preservation rhinoplasty.

The terms, defined

What the words in a hump-reduction plan mean.

  • Dorsal hump: the profile convexity made of nasal bone above, dorsal septum and upper lateral cartilages below, meeting at the rhinion.
  • Component reduction: taking the hump down in separate layers and steps rather than in one pass, to protect the upper lateral cartilages. [15457053]
  • Dorsal aesthetic lines: the paired highlight lines from brow to tip; what the nose looks like from the front. [15457053]
  • Open-roof deformity: the flat gap left between the nasal bones after a hump is removed and not closed. [15457053]
  • Inverted-V deformity: the shadow where nasal bones end and collapsed upper lateral cartilages begin. [15457053]
  • Spreader graft: a strip of septal cartilage, roughly 1–2 mm wide and 3–4 mm high, set between septum and upper lateral cartilage to hold the middle vault open. [6695022]
  • Autospreader (spreader flap): the upper lateral cartilage itself folded inward and fixed, instead of a separate graft. [42415377]
  • Osteotomy: the controlled cut that narrows or straightens the bony pyramid; usually medial and lateral, in a high-low-high line. [36594157]
  • Piezoelectric osteotomy: cutting bone with an ultrasonic tip that does not cut soft tissue. [42013314]
  • Dorsal preservation: the alternative: lowering the intact roof from below rather than removing it. [40227917]

Where else this is documented

Sources outside the journals, each one free to read.

The national guideline

The American Academy of Otolaryngology published a clinical practice guideline on nasal form and function after rhinoplasty, with a plain language summary written for patients. It sets what a surgeon should assess and document before the profile is lowered.

Rests on: the clinical practice guideline · the plain language summary.

The reference summary

Rhinoplasty in StatPearls, on the National Library of Medicine's Bookshelf, sets out the dorsal anatomy, the instruments and the complication list in free full text.

What is not settled

  • Whether removing the hump or preserving it produces the better nose. Four randomised trials favour preservation on patient-reported scores; the largest functional meta-analysis finds no difference; cohorts show the gap closing by twelve months. [40227917, 42532128, 42053436]
  • Whether prophylactic autospreaders prevent the inverted-V they are placed to prevent, one cohort shows they preserve width and function, and no trial tests the prevention claim. [42415377]
  • Piezoelectric instruments clearly reduce bruising and swelling; their effect on operating time is unresolved and cost is rarely reported. [42013314]
  • Bony vault asymmetry is documented in a third of patients, and no outcome study tests whether cutting the two sides differently changes the result. [36594157]
  • The component technique's central claim, that it reduces the need for spreader grafts in primary rhinoplasty, has never been tested against a control group. [15457053]

Written by rhinoplasty.cc from the sources linked above, 2026-09-09.

Who publishes on dorsum and hump

Ranked surgeons with papers under this topic in the archive, most first.

Sam P. Most (22) · Rod J. Rohrich (14) · Dean M. Toriumi (10) · Aaron Kosins (7) · Jason Roostaeian (6) · Jose Barrera (4) · Jacob Unger (3) · Michael Lee (3) · Steven Pearlman (3) · Paul Nassif (2)

The literature: Dorsum and hump, 227 papers. Video: The bridge and the hump, 291 videos. Every technique.