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`In the year 1896, there was a famous merchant in Berlin, who was easily recognized by his long humpy nose and a big moustache. The man came to Jacques Joseph asking him, `Do you think you can make my nose smaller?`, and Joseph replied, `Certainly`. A few weeks later, people in Berlin saw the merchant with his moustache, but his prominent nose was gone`. The instruments devised by Joseph, (the chisel, saws and retractors,) are still used today.

The patient with a hump, during his first consultation always requests a smaller nose. The clinical translation of this is a balanced nose; the patient means more definition, more refinement, symmetry, a straight nose and patent airways.

Hump removal is a vital step in rhinoplasty. The surgeon should take into consideration the patient's height, age, race, origin and local social and traditional manners, for example, in the Gulf areas both males and females do not like retrousse dorsum, they prefer a straight or slightly higher profile, while women from Lebanon, Syria, Egypt and Europe like more tip projection.

  1. Cartilagenous hump removal
    • Cartilagenous hump is incised as a single unit by using Fomon scissors or blade No. 11. (Fig. 17 - 10)
    • The scissors or blade is passed through all the three components of the cartilagenous hump: (Fig. 6 - 4 and Fig. 17 - 2)
      Left and right upper lateral cartilages and the septum.
    • The superior septal angle:
      It is preferred in humpy and long noses to leave the superior septal angle intact until the end of the procedure, because these patients may have underprojected tip, short columella and short caudal septum. Therefore, in actual fact, in these situations, in order to achieve a balanced dorsum, the superior septal angle may need to be augmented with a suitable graft following tip plasty. If the superior septal angle is routinely lowered with the hump, it will cause supratip collapse and need extra augmentation procedures at the end of the operation.
  2. Bony hump removal
    • This may be removed on the conjunction with the cartilagenous component with an osteotome. (Fig. 6 - 5)