Dorsal Hump Removal London

A dorsal hump is a bump or convexity on the bridge of your nose, visible in profile. It's the single most common reason people seek rhinoplasty, and one of the most satisfying to correct, because even a small change to the dorsal profile transforms the entire side view of your face.

The hump itself is made of two components: bone in the upper third and cartilage in the middle third of the nose. Most humps are a combination of both. Understanding the proportions matters because the surgical approach differs depending on whether you're primarily dealing with excess bone, excess cartilage, or both.

Some dorsal humps are hereditary: they run in families and become more prominent after puberty as the nose reaches adult size. Others develop after nasal trauma, where displaced bone or cartilage creates an irregular profile. The approach to correction is the same regardless of cause.

There are fundamentally two ways to remove a dorsal hump, and the choice between them is one of the most important decisions in your surgery.

Preservation rhinoplasty (let-down technique)

This is the modern approach that I use whenever the anatomy allows it. Instead of removing the hump by shaving down bone and cartilage from the top (the traditional method), preservation rhinoplasty works from underneath. The entire dorsal framework is loosened and lowered as a single unit, the “let-down” technique.

The advantage is that you keep your natural dorsal aesthetic lines, the smooth, continuous contours along the sides of the bridge that give a nose its character. Traditional hump removal destroys these lines and requires reconstruction, which is why some rhinoplasty results look “done” or show visible irregularities along the bridge.

Preservation rhinoplasty also means less bruising, less swelling, and faster recovery, because you're moving structures rather than removing them.

Structural (component) dorsal reduction

In some cases (very large humps, significantly deviated noses, or revision cases where the dorsal anatomy has already been altered) preservation techniques aren't possible. Here I use controlled component reduction: the cartilaginous and bony dorsum are reduced separately with precision instruments. I then perform lateral osteotomies (controlled bone cuts) using piezoelectric (ultrasonic) instruments to close the “open roof” that dorsal reduction creates.

The ultrasonic instruments are critical here. Traditional chisels create uncontrolled fracture lines. Piezoelectric instruments cut bone with sub-millimetre precision while leaving the overlying soft tissue unharmed. This means less bruising, less swelling, and more predictable bone position.

When you remove a dorsal hump using the traditional approach, you create what surgeons call an “open roof”: a flat, wide area on the bridge where the peak of the hump used to be. If this isn't addressed, the bridge looks flat and overly wide from the front.

Closing the open roof requires lateral osteotomies, controlled cuts through the nasal bones on each side that allow them to be moved inward. This is where the difference between ultrasonic and traditional techniques is most apparent. With a chisel, the fracture line is unpredictable and the bone segments can shift unevenly. With piezoelectric instruments, the cut is precise, the bone moves exactly where intended, and the risk of asymmetry is significantly reduced.

Preservation rhinoplasty avoids the open roof problem entirely, because the dorsum is lowered as a complete unit rather than having its peak removed. This is one of its major advantages for dorsal hump correction.

This is a common question. The short answer is: sometimes, but usually not advisable.

Technically, a hump can be reduced in isolation. But the nose is an integrated structure. Reducing the bridge height without adjusting the tip often creates an imbalance where the tip appears too prominent or under-rotated relative to the new profile line. Most patients who come in wanting “just the bump removed” end up agreeing at consultation that minor tip work would give a more harmonious result.

There is also the question of non-surgical options. Injectable fillers can camouflage a mild dorsal hump by filling the areas above and below it, creating a straighter profile. This is temporary (12 to 18 months), doesn't actually remove the hump, and adds volume to a nose rather than reducing it. I don't offer non-surgical rhinoplasty because I believe it creates unrealistic expectations and delays patients from pursuing the definitive surgical correction they actually want.

If osteotomies are performed (bone cuts to narrow the bridge after hump removal), expect bruising under the eyes for 7 to 14 days. With ultrasonic osteotomies, bruising is typically less than with traditional techniques, and many of my patients have minimal bruising by day 10.

A splint is worn for one week. Most patients return to desk work within five to seven days. Social confidence typically returns at two weeks. Exercise can resume at four to six weeks depending on the activity.

The bridge profile is visible almost immediately once the splint is removed, unlike tip work, where swelling obscures the result for months. This makes dorsal hump removal one of the most immediately gratifying rhinoplasty procedures. What you see at one week is close to the final result, with minor refinement over the following months as residual swelling resolves.