Hump reduction rhinoplasty is a nose-reshaping surgery that corrects the excessive fullness along the bridge whose upper third is made up of bone while the remaining two-thirds is composed of cartilage (firm but slightly flexible tissue).
While the surgery may seem like a straightforward procedure, the truth is that it goes beyond rasping the excess bone and trimming some cartilage.
Dr. Tarick Smiley, one of the leading Los Angeles plastic surgeons, shares the core principles of hump reduction rhinoplasty that allow him to deliver natural and permanent results.
- The deep radix must be addressed.
Occasionally, the fullness of the bridge is exacerbated by the deep radix, which is the root or origin of the nose from the forehead. Hence, some patients require this area to be filled in with soft tissue graft or cartilage to create smoother transition and balanced results.
Removing the excess cartilage does eliminate the hump, although this alone may result in open roof deformity, which is a visible gap. To prevent this surgical stigmata, a chisel-like device is used to cut the bone, allowing it to be narrowed and repositioned later on.
- Identify the most ideal amount of reduction.
Several variables determine how much reduction can provide the most natural and “stable” results; these include the nasal skin (particularly its shrinkage), facial features, gender, ethnicity, and even body frame (i.e., a bigger nose looks generally attractive in tall muscular men).
Over-aggressive reduction, especially in men, can result in unnatural appearance, disproportionately small nose (in relation to the face), and increased risk of nasal collapse and deformity.
- Closed rhinoplasty offers a unique advantage.
There are two basic methods to perform rhinoplasty: closed and open. The closed technique refers to placing all the incisions along the inner lining of the nostrils, while the open technique includes cutting the columella (wall of tissue between the nostrils) so the “roof” of the nose can be lifted, thereby giving more visibility during surgery.
While the open technique provides improved visibility, Dr. Smiley said closed rhinoplasty paves way for more predictable results.
“Because the columella and the roof of the nose remain intact during closed rhinoplasty, we see the outside appearance as we change the underlying framework step-by-step,” Dr. Smiley said in his previous Snapchat post.
Hump reduction rhinoplasty entails trimming the excess cartilage that is responsible for the “fullness.” But instead of throwing this away, in many circumstances it can be reshaped and later on used to reinforce the new contour of the nose, especially its tip, giving it a more refined appearance.
Great rhinoplasty results are impossible to identify because there are no surgical stigmata and the new nose looks in harmony with the face. Hence, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says he performs meticulous facial and nasal analysis that takes into account each patient’s ethnicity and gender as well as the established guidelines of aesthetics.
The ideal nose is not defined by a strict set of traits, although there are beauty tenets that can guide the surgeon to achieve natural results from rhinoplasty, or nose job in layman’s term. For instance, the width of the nose is ideally contained within the space or distance between the inner eyes; however, this does not apply to some ethnic noses such as the African that can tolerate a slight nostril flare without losing its attractiveness.
This before-and-after photo shows how meticulous rhinoplasty techniques can improve facial proportion, attractiveness, and even perceived youthfulness.
During the sixties and seventies, some doctors erroneously idealized the “ski jump” nose, which is manifested by having a narrow profile, with a dip in the middle and an upturned tip appearance. This highly specific aesthetic goal does not give justice to ethnic beauty and in fact may even look unnatural in a many Caucasian patient with strong chin and broad forehead.
Fortunately, the tenets of facial plastic surgery nowadays are culture and ethnic sensitive. After all, the vast majority of patients today define great rhinoplasty results as something that looks in harmony with their face.
But what constitute a natural-looking, attractive new nose?
Dr. Smiley says rhinoplasty is a “perfect amalgamation of art and science,” requiring precise measurement of the nasal and facial dimension. The quintessential goal, he says, is to create a new nose that “naturally occurs within the context of the patient’s ethnicity, gender, and pre-existing anatomy.” Hence, great results generally show subtle to moderate improvements, as opposed to a complete overhaul. After all, the basic architecture of the nose can only be changed to a certain degree.
Meanwhile, a nose that looks “done” is not in sync with the patient’s facial features, ethnicity, and gender. Or it has the classic signs of surgical enhancement such as hanging or very visible columella (wall between the nostrils), incorrect tip angle (too upturned or too elongated), collapsed appearance, and overly narrowed profile.
These classic signs give rhinoplasty a bad rep, while great results remain unseen or unappreciated because after all, they look as if the patients were born with the attractive nose.
Dr. Smiley, who has performed more than 2,000 rhinoplasties as of this writing, says that prudent patients should choose their surgeon carefully (he or she must have extensive experience and an eye for detail, and a member of the American Board of Plastic Surgery) to achieve results that will satisfy them long term.
Rhinoplasty, or nose job in layman’s term, is either performed through an open or closed technique incision; this allows the surgeon to reshape the cartilaginous and bony framework of the nose to improve its “outside appearance.”
Renowned Los Angeles plastic surgeon Dr. Tarick Smiley says he prefers the closed technique in which the incisions are limited inside the nostril, thus reducing any risk of visible scar. The open rhinoplasty, meanwhile, cuts the columella or wall separating the two nostrils to lift the “roof” of the nose before reshaping the underlying framework.
The female patient receives the closed rhinoplasty technique known for its shorter recovery or social downtime.
“About 95 percent of my rhinoplasty is done through closed technique,” Dr. Smiley said in his recent posts on Snapchat that demonstrated two female patients who have had nose-reshaping surgery.
The celebrity plastic surgeon has explained the “core” benefits of closed rhinoplasty:
- More control and increased predictability over the final results
Some surgeons argue that the open technique provides more control over the final results due to the improved visibility since it allows them to raise the roof of the nose. However, Dr. Smiley says it comes with one major caveat: They do not see the “outside appearance” of the nose while they are reshaping the underlying framework.
Meanwhile, the closed rhinoplasty technique allows the surgeon to reshape the underlying framework and see and examine the outside appearance of the nose in “real time.”
“Just like you’re molding a piece of clay it is better to see it every time you do it step by step,” he explained in the videos.
Compared to the open technique, closed rhinoplasty causes less disruption and injury to the soft tissue, leading to less bruising, pain, and swelling, which in turn contributes to shorter recovery.
Contrary to popular belief, most patients are concerned about the “social downtime” than the pain (which in most cases is well controlled by medications). With closed technique, many patients can expect to look presentable after a week, versus 10-14 days when open rhinoplasty is performed.
With closed rhinoplasty, there is no external scar across the columella. It is important to note that open rhinoplasty often results in barely detectable scar, although a small percentage of patients have experienced less than optimal scar.
Rhinoplasty for ethnic nose has one primary goal: improve the nose in a way that it will remain consistent with the patient’s ethnicity and facial features. Meanwhile, any attempt to reshape it using a set of highly restrictive beauty ideals will lead to unnatural results.
Dr. Tarick Smiley, who is the medical director of the California Surgical Institute, says the success of rhinoplasty, or nose job in layman’s term, boils down to acknowledging the great variations of beauty as well as respecting the patient’s underlying anatomies, ethnicity, gender, and aesthetic goals.
The vast majority of successful rhinoplasty for ethnic noses performed on women delivers “finesse” results. On the other hand, over-narrowing of the tip, over-augmentation of the bridge or dorsum, and over-tapering of the nostrils almost always lead to ethnically inconsistent results.
“Finesse” rhinoplasty generally means creating a result that is a more refined version of the original nose.
Respecting the patient’s ethnicity and underlying anatomies also entails the use of conservative surgical maneuvers, meaning the surgeon avoids over-resection of the tissue. In a way, this preserves the structural integrity of the nose and thus it is less susceptible to aging, deformity, and contour irregularity.
Before and after photos of ethnic rhinoplastic patient
One good example are patients of Middle Eastern and Indian descent who typically require dorsal hump reduction, a rhinoplastic technique in which the excessive fullness along the bridge is corrected by removing a piece of bone and cartilage, which is often re-used to improve the structural integrity of the tip.
In many cases, ethnic rhinoplasty deals with a tip that has weak support, causing it to droop and the nose to appear oddly elongated.
Reinforcing the tip has some auspicious effects on the femininity of the face. According to studies, the ideal female nose has an angle of tip rotation between 95 and 110 degrees, resulting in a slightly upturned appearance.
Again, raising the tip should be done in a conservative, finesse manner lest an error of just a few millimeters can lead to unusually short nose and excessive visibility of the nostrils, a deformity colloquially called as “Miss Piggy” in reference to the popular Muppet character.
The slightly upturned tip might be further enhanced with the small suptratip break, a slight indentation along the bridge just above the nasal tip. However, this “subtle” feature is avoided like a plague in male rhinoplasty due to its feminizing effects.
And lastly, female rhinoplasty for ethnic nose should take into account the patient’s aesthetic goals—which are largely influenced by social and cultural ideals of beauty—down to the last detail.
Male ethnic rhinoplasty is a broad term used to describe nose-reshaping surgery performed in men of ethnic descent. It is important to note that even within the same ethnicity variations do exist in terms of nasal anatomy, facial features, and aesthetic goals.
Hence, leading Los Angeles plastic surgeon Dr. Tarick Smiley says successful nose surgeries are highly customized procedure, respecting the “starting” anatomy of the nose, the unique facial features of each patient, his aesthetic goals (which are partly influenced by his culture), and even his body-frame and height.
While the ideal male nose is not defined by highly restrictive standards, the renowned facial plastic surgeon says there are definite philosophies and universal aesthetic guidelines that help doctors achieve more attractive and natural results from rhinoplasty.
- The attractive male nose has a strong appearance.
Several aesthetic variables that determine a strong, attractive male nose include a slight hump or fullness along the dorsum (bridge), an angle of tip rotation between 90-95 degrees, and a bigger size compared to women (of the same height).
The tip rotation, or the angle between the upper lip and nasal tip, is one of the most critical aspects of male rhinoplasty. It should appear straight or sometimes even slightly droopy to look gender appropriate; in no way it should be over-rotated since even the slightest upturned appearance can make the results look delicate and feminine.
- The patient’s face should be taken into account.
A good number of male ethnic rhinoplasty surgeries are performed to reduce the width and/or height of the nose, making it more proportionate to the face. However, over-reduction is avoided like a plague because a male nose is naturally bigger than a female nose.
- His height and body frame will partly determine the ideal nose size and appearance.
In general, a taller, more muscular male may benefit from a stronger and more elevated bridge and a longer nose than a shorter, leaner man.
- Consideration of some shared anatomies and features.
Respecting the patient’s anatomy is one of the keys to preserve natural-looking, long-lasting results. While “strict” generalization does not give justice to the wide variations of ethnic male noses, it is important to note that they have some shared traits such as thicker nasal skin, more bulbous tip (compared with Caucasians), and less supportive cartilage.
Markedly thick skin does not show all the details of rhinoplasty, although they are more forgiving compared to very thin skin which can show even the smallest contour irregularity.
Patients with markedly thick skin should not have their tissue over-resected because the overlying skin may not drape well especially around the tip, leading to its amorphous appearance.
Rhinoplasty, or nose job in layman’s term, is generally performed to improve the “outside” appearance of the nose, which is accomplished by reshaping the underlying bone and cartilaginous framework. Hence, the skin must be able to shrink-wrap around the new contour to show the details and improvements brought on by the surgery.
Occasionally, rhinoplasty has inadvertent but favorable effects: improved airflow. This is particularly true when the surgery is combined with septoplasty, a surgical technique in which the crooked or deviated septum (wall of tissue between the nostrils) is straightened, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Some athletes have sought rhinoplasty combined with functional nose surgery to improve their breathing, which can have a large influence on their performance and endurance.
People with deviated septum have poor airflow, which interferes with their oxygen intake. As a result, they find it difficult to train in high-altitude environment and they cannot increase the intensity of their exercise routine without feeling wipe out.
And because of suboptimal oxygen intake, people with deviated septum also have poor quality of sleep. In fact, their heart and lungs work harder during sleep, instead of being at a more relaxed state, to compensate for the reduced oxygen level.
More often than not, athletes seeking nose-reshaping surgery ask for subtle and natural results. This is one of the most critical rhinoplasty guidelines that will influence patient satisfaction.
While the surgery involves hump reduction, the patient benefits from minimal fullness along the bridge to complement the stronger nasal tip.
For instance, some male athletes who ask for hump reduction specifically instruct their surgeons to preserve some minimal “fullness” along their bridge. Hence, the success of rhinoplasty also boils down to good patient-doctor communications.
Others seek rhinoplasty to correct the deformities that stemmed from previous trauma. Oftentimes, these patients simply want the appearance of their “original” nose.
It is important to note that the surgery’s success also relies on patient commitment and cooperation. For instance, strenuous physical activities, especially contact sports, must be avoided for at least six weeks to prevent nose bleeding, persistent swelling, and injuries that can compromise the results.
Meanwhile, the frequency of nasal trauma and the kind of sports patients are engaged to are taken into account during patient selection process. Hence, professional boxers who seek aesthetic rhinoplasty are generally considered poor candidates for the surgery.