Nasal hump cor­rection.

Our patients come to us with a wide variety of concerns: many would like a troublesome hump removed, others the straightening of a crooked bridge or the building up of a flat profile. What they have in common is the wish for a harmonious, natural result that fits their face perfectly.

At the Kuzbari Centre we rely on individual solutions that underline your natural beauty without looking artificial.

The nose bridge is not one continuous component but a junction. In the upper third it consists of bone — the two nasal bones, which widen towards the nasal root. Below that, cartilage takes over: the two upper lateral cartilages, which lie like a roof over the nasal septum. It is exactly at the point where bone and cartilage meet that the highest point of the nose bridge sits in most people.

A hump is therefore usually both: a bony and a cartilaginous portion, which together project beyond the ideal profile line. That is why it falls short simply to “file down” a hump — this would leave the cartilaginous part untouched, and once the swelling had gone a residual bulge would remain.

A second insight from the anatomy is more important still: some humps are not genuine humps. If the nasal root — the transition from the forehead to the nose — lies very deep, the nose looks arched in profile even though the nose bridge itself is not too high at all. Here removing tissue would be the wrong course. What is right is to raise the nasal root gently; this makes the profile line straight without the nose becoming smaller. We make this distinction at the examination and show it to you in the 3D simulation, because it determines the entire surgical strategy.

The causes of a genuine hump are almost always unspectacular. Usually it is constitutional and grows out with the face during puberty — one reason why many patients say that their nose “changed at 15”. Less often it develops after a fracture, when bone edges heal together out of alignment; the hump is then frequently combined with a crooked nose.

We work extensively with the modern nose-bridge-preserving technique, known as dorsal preservation, as well as with hybrid techniques — not exclusively with the traditional structural septorhinoplasty. The natural nose bridge is preserved rather than removed and rebuilt.

With hump correction this difference is particularly tangible. If a hump is removed, an open surface is created at the point where the roof of bone and cartilage previously met. It then has to be closed again and rejoined — in our hands with supporting elements that secure the width and the line of the middle third of the nose. The profile line you see afterwards is a reconstructed line.

With the nose-bridge-preserving technique this roof remains untouched. The height is reduced lower down: a precisely measured piece of material is taken from the nasal septum and, depending on the variant, from the area beneath the nasal root. The entire nose bridge lowers as a unit and keeps the surface it has grown with. The hump disappears — the line remains your own, simply set lower.

This has three advantages. The result looks particularly natural. It is stable in the long term. And the risk of later irregularities on the nose bridge is reduced — which matters above all with thin skin, because there even the smallest edge becomes visible. Certain deviations from the midline also recur less frequently.

Dorsal preservation is therefore not generally superior, but for many findings it is the gentler choice. If the nasal septum is severely deformed, if material is missing after previous operations, or if the hump is very pronounced while the nasal root sits too low, a structural reconstruction may be the better solution. Often the best route is a hybrid technique at the nasal bridge: part of the bridge is preserved while other structures are modified in a targeted way — the advantages of dorsal preservation remain, and the range of cases it suits grows. The decision is made on your findings, not from a catalogue.

Whenever the bony part of the nose has to be altered during a rhinoplasty, we work with a piezotome. This is an ultrasound instrument that cuts and smooths bone while leaving the soft tissue, the mucous membrane and the blood vessels untouched — classically this step is carried out with a chisel and a saw. For patients it means more precise work on the bone and, as a rule, fewer bruises and less swelling in the days that follow.

An honest classification matters to us: the piezotome is not a method of rhinoplasty in its own right and it does not automatically make a nasal operation better. It is a tool for one step of the procedure. What remains decisive is the planning and the experience of the surgeon. We use the piezotome as standard in every nasal operation; Univ.-Doz. Dr Rafic Kuzbari has been doing so for years.

A rhinoplasty with us takes one to four hours. This range is deliberate: we operate in our own operating theatres and therefore without time pressure — for as long as it takes until every detail is right. How long a procedure takes is decided by the findings, not by the appointment schedule.

An isolated hump correction via the closed approach lies at the lower end of this range. If straightening of the nasal septum is added, or cartilage-supported stabilisation of the nasal tip, or raising of the nasal root, it takes longer. The more elaborate variant is not a more refined version of the same operation, but the technique that these findings require.

Incidentally, the step that takes up the most time on the nose bridge is checking. After every change the line is examined again from the side, from the front and with the finger — because an edge that is not yet apparent in the operating theatre may become so once the swelling has gone down. These repetitions are the reason why we do not save the last half-hour.

The nose bridge and the nasal septum are one connected structure: the septum supports the bridge from within. Anyone lowering the bridge therefore inevitably works on the septum — and thus on the structure that determines breathing.

For you this has two consequences. The first: a hump often goes together with a deviated nasal septum, particularly where there is a fracture in the history. Correcting both in one procedure is the obvious route — one anaesthetic, one healing phase. The second: hump correction means working in exactly the area where the internal nasal valve lies, the narrowest point of the entire airway. Its width has to be secured there, otherwise a beautiful profile line can make breathing worse. Where required we insert narrow strips of cartilage that keep the valve open and at the same time stabilise the line of the middle third of the nose.

This is why we also examine nasal breathing in every hump correction — and include it in the plan, even if you come to us with a purely aesthetic concern.

How much of a hump should go is not a universal figure. A profile looks harmonious when the line of the nose matches the forehead, the chin and the upper lip — and these reference points differ from face to face.

A receding chin makes every nose appear larger in profile; a hump correction has a stronger effect here than in a face with a strong chin. A high, prominent forehead can carry a slightly higher nasal line. And the angle between nose and upper lip changes the perception of the length of the nose without anything changing on the bridge. This is precisely why we never assess a hump correction in isolation, but always in the context of the whole profile.

The impression you wish to achieve also plays a part. Many female patients would like a very gentle curve to the nose bridge; many male patients expressly wish to keep a straight line and to have only the convexity removed, so that the profile remains strong. Both are readily achievable — and we discuss both on the simulation, not against an ideal of beauty.

What we do not do: give a nose a shape that does not work in the rest of the face. If a desired profile taken from a photograph would not carry in your face, we say so — and show you in the simulation why.

Age. For aesthetic indications we operate once facial growth is complete — as a rule from about the age of 16 in women, somewhat later in men. This is particularly relevant with a hump, because it often only develops during puberty; anyone operated on too early has a nose corrected that is not yet finished. There is no upper age limit: what matters is general health and tissue quality.

After a fracture. If the nose has just been broken, there is a short window in which the bone can be realigned without a major procedure. Once this window has passed, one waits until everything has healed — and then corrects the hump, the deviation and the nasal septum in one planned procedure. This is not a disadvantage: a planned correction generally leads to a more precise result than an immediate measure.

Everyday life and the calendar. Allow two to three weeks in which you do not have to be in the spotlight. Contact sports are out for a longer period, and glasses may only rest on the nose bridge again once we have given our approval. If you are working towards a fixed date, allow generous time — at least six months, and rather twelve with thick skin.

And the most important point. A rhinoplasty is a good decision when it comes from your own calm wish. Under pressure from those around you, or during a stressful phase of life, we advise postponing the procedure. The consultation about it is without obligation.

Readily achievable: a hump that disappears. A profile line that runs straight or gently curved — exactly as planned. A nose that is no longer the first thing one notices in profile. And a result that no one recognises as operated on.

There are limits, too. A hump correction does not automatically make a nose smaller: anyone who feels their nose is too large overall needs more than a lowering of the bridge. Skin thickness cannot be changed — with thin skin we deliberately plan more conservatively, because there every edge would be visible. And healing is individual: how tissue settles over the months can be planned, but not forced. A small proportion of all nose surgery requires a minor secondary correction; that applies to us as well, and we say so beforehand.

What we advise against: a perfectly straight, almost sunken profile line where it does not suit the face — it quickly looks contrived and makes the nasal tip appear longer over the years. And an isolated hump correction where there is at the same time a drooping nasal tip or a marked deviation: the correction would then stop halfway.

An initial consultation with three-dimensional simulation, a technique that suits your nose, and an operating time that follows the findings — this effort is the reason why rhinoplasty with us has its price. It is also the reason why the result is meant to hold: for a lifetime, not for a few years.