An attractive nose has a straight or near-straight profile. Therefore, nasal humps are commonly shaved during rhinoplasty surgery. Although so commonly performed, creating a natural looking and attractive nose depends frequently on the quality and approach with nasal hump removal.
Almost all nasal humps consist of bone and cartilage. Both need to be sculpted for a natural look. The cartilage is usually shaved sharply with a scalpel although some surgeons prefer the use of scissors. When an open rhinoplasty is performed, some surgeons separate the side cartilages (i.e. upper lateral cartilages) from the septum first and shave the cartilage from the septum only. Others (and also during endonasal closed rhinoplasty) remove the cartilage bump by incorporating both the septum and the very top edge of the upper lateral cartilages.
In experienced hands, both approaches can lead to good results. Both techniques may lead to irregularities afterwards requiring touch-up surgery. Some people have rather large nasal humps while others may have rather small elevations.
In general, the nose profile represents one of the reasons why patients may seek a touch up procedure after rhinoplasty. Even very experienced surgeons may find at the end a small remaining bump. Patients commonly ask: Did this grow back? Bumps usually do not grow back but the initial puffiness may camouflage the remaining height at the beginning and as the swelling resolves this becomes apparent.
Removing a sliver more of some bone or cartilage is a relatively easy and straight-forward procedure with minimal downtime. Because it is much more challenging to put tissue back in once too much has been removed, an expert rhinoplasty surgeon will likely tend to err on the side of conservatism. Your nose specialist will also consider the patency of your nasal airway during the hump shaving and the following osteotomies (narrowing of the nose).
Other Techniques: Push-Down Procedure
Innovative surgeons have popularized a different approach to the nasal bump called the nasal push-down procedure. Here, the bridge of the nose is left intact but the whole nose is brought backwards by removing slivers from the side bones and the septum. This leads to a controlled collapse of the nose, the extent of which depends on how much bone is removed. Although rhinoplasty specialists from abroad (i.e. Latin America etc.) practice the push-down procedure successfully, it was never and is not currently popular in the US.