The nose bridge (nasal dorsum) is the ridge running from between the eyes down to the tip of the nose. Its upper third is made of the paired nasal bones and its lower two-thirds of cartilage. Bridges vary in height, width and straightness because of genetics, ethnic background and injury, and rhinoplasty can lower, narrow, straighten or build up a bridge where an adult wishes to change it.
What the bridge is made of
The top of the bridge, sometimes called the radix, sits at the level of the upper eyelid crease. Below it, the two nasal bones form a firm arch. Where the bones end, the upper lateral cartilages take over, joined in the midline to the septum, the wall that divides the two sides of the nose. The junction between bone and cartilage, known as the keystone area, is where a hump most often forms. Skin over the bridge is usually thinnest in the middle, so small irregularities of bone or cartilage can show more easily here than at the tip.
Common bridge shapes
- Straight bridge: a smooth line from the radix to the tip with no obvious bump or dip.
- Dorsal hump: a convex bump of bone and cartilage, often inherited, and sometimes more visible in profile than face on.
- Low or flat bridge: little projection between the eyes, common in people of East Asian and African heritage and entirely normal.
- Wide bridge: broad nasal bones, which may make the eyes appear closer together or the nose heavier.
- Crooked bridge: a bridge that deviates to one side, frequently after a knock or linked to a deviated septum.
- Saddle deformity: a scooped-out dip in the cartilage portion, which can follow injury, septal damage or previous surgery.
Why bridges change over time
The bridge reaches its adult shape once facial growth finishes, typically in the late teens. A hump that was barely visible in childhood may become obvious during this period. Later in life, the bridge itself changes relatively little, but the tip can droop as its supporting tissues weaken, which can make a hump look more pronounced. Injuries are a frequent cause of change at any age: a broken nose may heal with a bump, a sideways shift or a flattened area. Damage to the septum, from injury, infection or previous operations, can cause the cartilaginous bridge to collapse into a saddle shape.
When to see a doctor
See your GP if a change in the shape of your bridge follows an injury, particularly if breathing through one side has become difficult. After a facial injury, go to A&E the same day if you have clear fluid running from the nose, a swelling inside the nose that blocks it, heavy bleeding that will not stop, or problems with your vision. A bridge that slowly collapses without injury should also be assessed, because inflammatory conditions and septal perforation can occasionally be responsible.
Non-surgical options
Dermal filler can be placed above and below a small hump to make the profile look straighter, or used to build up a low bridge a little. This adds volume rather than removing it, lasts for a limited time and does not straighten a crooked nose or improve breathing. Filler on the bridge carries a small but serious risk of blocking a blood vessel, which can affect the skin and, rarely, vision, so it should only be given by an experienced medical practitioner. Some people prefer to trial a change this way before considering surgery.
Surgical options for the bridge
In rhinoplasty, a hump can be reduced by carefully rasping bone and trimming cartilage, and the bridge rebuilt so it stays smooth. A wide or crooked bridge may need controlled breaks of the nasal bones (osteotomies) so they can be moved inward or into the midline. A low or saddle bridge can be built up with cartilage grafts, usually taken from the septum or ear. Some surgeons use preservation techniques that lower the bridge without removing its surface; see preservation rhinoplasty explained. Mr Nassab will look at the bridge in relation to the tip, chin and forehead, because the right height for one face is not right for another.
Recovery and cost
After bridge surgery a splint is usually worn for around a week. Bruising around the eyes typically fades over two weeks, while fine swelling along the bridge settles over several months. Rhinoplasty costs from £8,950 and the £150 consultation fee is separate. Cosmetic nasal surgery is only for adults aged 18 and over whose nose has finished growing.
Frequently Asked Questions
Can a nose bridge be made smaller without surgery?
Filler can disguise a hump by straightening the profile, but it cannot reduce the size of the bridge. Only surgery removes bone or cartilage.
What causes a bump on the nose bridge?
Most bumps are inherited and form where bone meets cartilage. A previous knock can also leave a bump as the nose heals.
Can a low bridge be raised?
Yes. A low bridge can be built up with cartilage grafts during rhinoplasty, or temporarily with filler in selected people.
Will reducing my hump change my breathing?
Hump reduction alone does not usually affect breathing, but the internal support of the nose must be preserved or reconstructed, which is part of careful surgical planning.
