Dorsal hump (bump on the bridge)

A dorsal hump is a bump on the bridge of the nose, seen most clearly from the side. It is one of the most common reasons people ask about rhinoplasty. The American Society of Plastic Surgeons (ASPS) lists “visible humps or depressions on the bridge” among the profile problems that rhinoplasty can address.

This guide explains what a surgeon looks at before lowering a hump, the main techniques, what is realistic, and what can go wrong. It does not replace a consultation. Your anatomy decides the plan.

What is a dorsal hump?

A dorsal hump is an area of the nasal bridge that sits higher than the line between the root of the nose and the tip. It can be bone, cartilage, or a mix of the two. The “dorsum” is the name for the bridge, which is why surgeons say “dorsal”.

A hump is not a medical problem in itself. Whether to change it is a choice about appearance. The nose also has to keep working: the upper part of the nose is held up by the bone and by cartilage that also forms part of the airway. That is why hump surgery is never only a matter of shaving something flat.

How does a surgeon assess a hump?

A surgeon assesses a hump by looking at the whole nose, not only the bump. StatPearls describes a standard assessment that includes:

• a history, including earlier nose surgery, breathing problems, sleep apnoea, chronic sinusitis, bleeding disorders and any psychiatric condition such as body dysmorphic disorder;
• standard photographs from the front, both sides, three-quarter, from below and from above;
• the skin and soft tissue over the nose, which is thinnest over the upper bridge and thickest in the lower third;
• a measurement of angles, for example the angle between forehead and nose, which StatPearls gives as roughly 115 to 130 degrees in Caucasian patients and lower in Asian, Latin and African patients;
• an examination of the airway, including a check of the internal valve and, if needed, a look inside with an endoscope.

Cleveland Clinic describes the same first steps: a consultation about your goals, an examination, measurements of the face and photographs. Bring pictures of results you like, and a list of your medicines and supplements.

Which technique usually lowers a hump?

Most hump reductions remove the projecting bone and cartilage and then reshape the bridge. StatPearls describes two broad approaches.

Resection. The surgeon cuts the cartilage part of the hump, from the front of the septum to the point where bone and cartilage meet. The bony part is reduced with a rasp, an osteotome (a small chisel) or a piezotome, which is an ultrasonic instrument. See the guide to ultrasonic (piezo) rhinoplasty.

Dorsal preservation. StatPearls describes “push-down” and “let-down” techniques that lower the bridge by removing a strip of septum, without separating the upper lateral cartilages from the septum. The guide to preservation rhinoplasty covers what this means for you. Ask a surgeon whether it suits your nose.

Either approach can be done through an open or closed incision. StatPearls says the endonasal (closed) approach suits hump reduction, spreader grafts and similar steps, and that the open approach is preferred for tip work. If your tip also needs work, expect your surgeon to discuss the open approach. If the septum is also bent, hump reduction is often part of a septorhinoplasty.

After the hump is lowered, the bridge can look wide or have an open gap at the top. Surgeons close that by breaking the nasal bones at the sides and moving them in. These cuts are called osteotomies. StatPearls describes them as medial and lateral osteotomies.

What result is realistic?

A realistic result is a smoother, lower bridge that suits your face, not a ruler-straight line. Three points from the sources are worth knowing.

First, StatPearls advises keeping a subtle hump where needed, because a fully flat bridge can produce a pseudo-saddle once the skin redrapes over it.

Second, the nose changes slowly. Cleveland Clinic says the first difference is visible about a week after the splint comes off, but full results usually appear after a year. See the recovery day by day guide and the swelling month by month guide.

Third, ASPS notes that everyone’s face is asymmetric to some degree, and results may not be completely symmetric.

What can go wrong with hump reduction?

The risks are those of any rhinoplasty, plus a few that belong to hump reduction. A paper on complications of primary and revision septorhinoplasty (PMC) says:

• taking too much cartilage from the sides of the nose while removing a hump can weaken the internal nasal valve and cause breathing trouble;
• lowering the bridge can unmask a septal deviation that was hidden before;
• bony spicules left after rasping, or poorly placed grafts, can leave an uneven bridge.

A single-centre study of 732 closed rhinoplasties found a revision rate of 8.6%, and cited literature rates of 5 to 15%. The most frequent aesthetic reason for revision in that study was a “pollybeak”, a fullness above the tip. Cleveland Clinic says about 15% of people need a revision operation. Read the risks and complications guide before you decide. If you need a second operation, see revision rhinoplasty. StatPearls says revision is generally delayed 6 to 12 months so the swelling can settle.

What should you ask before booking?

Ask how many hump reductions the surgeon does each year, and which technique they plan for your nose. Ask to see photos of their own patients with a similar hump, in the same lighting before and after. Ask what they would do if the bridge ends up too low or uneven. Our questions to ask a clinic guide has a longer list, and the how to verify a surgeon guide explains how to check a licence in Albania.

Next steps

Read how septorhinoplasty works if your breathing is also affected, and the recovery day by day guide so you know what the first weeks look like.