Doctor's Answers (1)
An uneven nose is usually a layman's description of a hump nose. Sometimes it is also used to describe a crooked nose. A dorsal hump refers to an obvious convexity on the bridge of the nose that gives the appearance of a hump on the nose on profile (side) view. This hump can be due to cartilage, bone or both. This is a very commonly requested change to the nose which can create a more aesthetic and feminine appearance.
A dorsal hump can be reduced using either closed (without scar) or open rhinoplasty approaches. Minor humps can be sculpted without an osteotomy (precise fractures to the nasal bone) to alter the bony structure of the nose. A rasp is used to file the dorsal hump down to make it smooth. If the hump is made from cartilage, it can be modified with a blade or scissors and sculpted to smoothly transition with the rest of the nasal bony vault. Occasionally, osteotomies are performed - this is usually part of a larger procedure or if the hump involves a larger part of the bony nasal vault.
Whilst the procedure can be rather simple it can create a profound change and improvement to the face. In certain cases, when the dorsal hump is removed, the nose may appear longer and a minor tip adjustment (elevation) is done to make the nose appear less elongated.
How much shall we lower the hump or elevate the tip? This can be assessed using 3D-morphing software to help you to understand the possible changes. Read my upcoming article on what a tip-pasty can do and how to take photos for online evaluations and also why a 3D assessment is important.
A crooked nose refers to a nose that doesn’t follow the dorsal aesthetic lines (these are straight vertical lines that run down the side of your nose). This crookedness may be very subtle or more dramatic depending on the cause. It could be due to a deviation in the septum or the nasal bones and there can be many causes from congenital (from birth) to nasal fractures. Occasionally, crooked noses are not only a cosmetic concern, but they can also affect your breathing.
Surgery can be done to improve both the function and the aesthetics of the nose. The causes and anatomical considerations for a crooked nose are more complex than assessing an uneven nose due to a dorsal hump. A detailed history and an internal examination will be needed to investigate the nasal septum. Occasionally scans are also done to visualise the bony structures to create a surgical plan. Please read my upcoming article on how to treat a crooked nose.