Reduction of the nasal hump is the most common request in surgical rhinoplasty. It follows that this is a common request in nonsurgical rhinoplasty as well. Many patients who present for this maneuver may actually be better surgical candidates, especially in the case of a large hump or a shallower radix. Computer imaging can be a helpful way to illustrate this to patients, because a very tall radix may be undesirable.
Placement of filler above and below the dorsal hump is a straightforward maneuver. If the hump is small, this can be done with a cannula in the supratip. For larger humps, placement at 2 points may be indicated, cephalad and caudal. A 29- gauge needle is most commonly used for this placement. Placement of the filler at the proper depth and aspiration, in particular at the radix, is very important. Depending on hump size relative to the radix, 0.2 to 0.3 mL of filler cephalic and 0.1 to 0.2 mL distal to the hump are generally sufficient. Similar to dorsal augmentation, the natural nasal starting point must be assessed. Distally, some patients desire a supratip break, whereas others prefer a straight dorsum