How can I correct an Open Roof Deformity? (Photo)

There are a few options when trying to correct an open roof deformity. Rebreaking the nasal bones through osteotomies may be the best option. However, in the case of a large open roof that is high on the nasal bridge or dorsum, it may be necessary to use a cartilage graft to act as a surrogate roof to correct the defect. Looking at your photos, it does seem reasonable that osteotomies would help with your defect. However, sometimes the best solution is only evident during surgery and I would anticipate using a graft but hope that osteotomies would be sufficient.

Correcting your open roof will probably require additional filing of the leading edge of the nasal bones as well as a corrective osteotomy to narrow  and close the open roof. Other techniques could perhaps be utilized, but you need to be examined to maske those determinations.

Your surgeon has the benefit of feeling your nasal bones and the area in question. I would err on the side of trusting his judgement as he was also the one performing your surgery. Either infracturing or grafts will work. I prefer infracturing the segments if possible as that will eliminate some of the hump you see on your 45 degree view. Grafts also tend to add height which may necessitate some rasping of your nasal bones to keep your profile straight and will not improve the width you see in your bony nasal vault. What matters most is what you like aesthetically. If you like a little width at the top, go with the graft, but if you like it straight then reinfracture y our nasal bones.  I hope everything turns out for the best.