Dr. William Portuese performs closed rhinoplasty when patients have a dorsal hump that needs to be removed. Removal of the dorsal hump is the most common reason patients seek out a rhinoplasty procedure. The dorsal hump is composed of 3 structures, which include the cartilaginous upper lateral cartilages, the cartilagenous dorsal portion of the nasal septum, and the nasal bones. These 3 items come together in the nose called the rhinion, which is a growth center for both cartilage and bone. A dorsal hump needs to be shaved down in to be able to remove it successfully. To remove cartilage, this must be cut with a knife or scissors. The bone can be cut with an osteotome, or filed down with a rasp, but it really depends on how large the bony dorsal hump is.
Dorsal hump removal with closed rhinoplasty
Removing the dorsal hump creates a flat-top, open roof nasal deformity. Once the dorsal hump has been removed, both medial and lateral osteotomies of the nasal bones are performed with an osteotome to narrow the nasal bones and close the open roof created from this nasal hump removal. Osteotomies and breaking the nasal bones inward are a necessity for the nose to look good in all 3 dimensions. Once the hump has been removed, some patients do not require any nasal tip work, while others may require the tip to now be balanced with the new bridge line. Minor or major tip adjustments can also be performed during a closed rhinoplasty procedure to make sure the entire structure of the nose balances with itself, and the entire new nose balances with the patient’s complete facial features. Once the hump and osteotomies have been performed, an Aqua-Plast cast is applied across the bridge line of the nose and left in place for 6 days. Patients will get some degree of bruising and swelling lasting approximately 10 days. Full healing is one year after rhinoplasty surgery. All of the incisions for a closed rhinoplasty are placed on the inside of the nose, and the incisions are closed with dissolvable catgut sutures, which fall out in about a week. Dr. William A. Portuese performs dorsal hump reduction rhinoplasty at the Seattle Rhinoplasty Center under general anesthesia as an outpatient surgical procedure. Board certified physician anesthesiologists are in attendance for patient safety and comfort.