Avoid the "open roof" deformity

As one of my colleagues below touched on, the problem with "only" rasping down the nasal bones is that the nasal bones and cartilage are quite thin--a few millimeters, really--so that anything more significant than a tiny hump will require rasping right through those thin plates of bone and cartilage. This creates what is known as an "open roof" deformity, which can become unsightly over time. To close the open roof requires cuts in the bone where the nasal bones meet the facial bones (well, the nasal processes of the maxillae).

I'm often surprised, though, by the term "breaking" the bones, which implies a brutal, imprecise, and painful process. Osteotomies--literally, bone cutting--should be precise, delicate, and minimally traumatic. Besides, even without osteotomies, the rasping of the bones and soft-tissue dissection required for even closed rhinoplasty is still a significant surgical procedure. The least of a patient's concern should be the osteotomies, if the patient is in the hands of a competent surgeon. The focus should always be on achieving a safe, natural, unoperated result that can withstand the test of time.

Correction of a small hump on the nose can be as simple as just filing the area down gently with a rasp under local or IV anesthesia. However, in some patients if it is a larger hump a flattening effect to the dorsum may result called an "open roof" and this might require breaking or infracturing the two nasal side bones to close the area that was filed down to prevent a flattened appearance. Even if the additional surgery is required it is considered minimal and shouldn't take the surgeon much longer to perform.

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