Dr. Buonassisi explains the step-by-step surgical process for reducing a dorsal hump — the most commonly requested rhinoplasty change.
In this video, Dr. Thomas Buonassisi walks through the surgical steps involved in dorsal hump reduction — one of the most frequently requested changes in rhinoplasty. He explains the anatomy of the osseocartilaginous junction, the difference between a bony hump and a cartilaginous hump, and why the technique used depends on the specific composition of the patient's hump. Dr. Buonassisi also addresses the open roof deformity that results from hump removal and explains how osteotomies are used to close it.
A dorsal hump is composed of both bone (upper third) and cartilage (middle third) — the ratio varies by patient.
In preservation rhinoplasty, the hump is lowered by letting down the dorsum rather than excising it, preserving the keystone area.
After hump removal, the nasal bones are left separated (open roof). Osteotomies are required to close this gap.
Over-reduction is the most common cosmetic complication — a small residual hump is preferable to an over-reduced, scooped profile.
Computer imaging at consultation helps set realistic expectations for the degree of reduction achievable.