V. (A) Taking Down the Hump

Patients often request correction of their "nasal bump." These patients typically desire a conservative profile change, creating a nose that is in harmony with the rest of their facial features.

The nasal hump is composed of cartilage and bone. There are several methods of taking down the nasal hump; one approach is described here (see Fig. 19).

FIGURE 19. An en bloc ("in one piece") resection of the nasal hump is author's preferred approach. In this method, the cartilage of the hump is incised with a scalpel (a). This creates a "joint" at the junction of the bone and cartilage, shown here. The bone knife or "osteotome" is then seated at the bone-cartilage junction (b). A gentle tap-tap technique is used to advance the osteotome through the bone in the desired path (c). The bone-cartilage hump are removed in one piece (en bloc).

When the patient is asleep but before being in­jected with local anesthesia, the surgeon may mark the skin of the nasal bridge as a guide in visualizing the precise amount of the hump to be removed. The sur­geon will have predetermined the amount of reduction needed, but the markings are a helpful guide. When computer imaging has been performed, the surgeon reviews the imaging goal before surgery and may have the photos in the room as an additional guide.

An en bloc ("in one piece") resection of the na­sal hump is the author's preferred approach. In this method, the cartilage of the hump is incised with a scalpel. This creates a "joint" at the junction of the bone and cartilage, as shown.

The bone knife or "osteotome" is then seated at the bone-cartilage junction as illustrated in the diagrams (the osteotome is extremely sharp, so it cuts through the bone easily). A gentle tap-tap technique is used to advance the osteotome through the bone in the desired path. The bone-cartilage hump are removed in one piece (en bloc).

The surgeon carefully examines the patient's nose and the bone-cartilage hump that has been removed. This careful evaluation guides the next step—fi ne tun­ing of the profile with additional excision of small amounts of cartilage, and filing or rasping of the bone to smooth it (see below).

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