Hello,I had my nose broken 7 months ago that left me with a crookedness that I 'm pretty sure its in the bony section.My doctor said that i may choose if I want the "smaller" surgery which involves only rasping the tip of the bone (she didn't mention anything about the cartilage) and off course my nose wont get any straighter but it will look better,or the "bigger" surgery witch involves osteotomies. What do you think about the first ? Is it possible ? And what about the cartilage ?
Rasping the Nasal Bones or Go for the Typical Rhino (Lateral and Medial Osteotomies)? (photo)
Doctor Answers (13)
Rasping Nasal Bones Only Will Not Correct Crooked Nose
Thank you for your question. Simply rasping the nasal bone to remove the bump will not correct the crooked nose. In addition there is risk of an "open roof" deformity where the 2 nasal bones become visible through the skin.
From your photographs it looks as if you need a formal rhinoplasty and nasal septoplasty to straighten the nose. Reduction of the bump and refinement of the tip can also be done during the course of the rhinoplasty.
Rasping of the Nasal Bones
As best I can tell with the pictures submitted, you have deviation of both the bone and cartilage of your nose following the trauma. After thorough evaluation by an experienced rhinoplasty surgeon who explains all your alternatives, you can decide what changes you want to make. If you'll be satisfied reducing the nose without making it straight, that is what you should do. You do have a lot of options. But remember, if you don't want osteotomies, the amount of hump removal is limited.
Rasping the Nasal Bones or Go for the Typical Rhino (Lateral and Medial Osteotomies)?
I have performed Rhinoplasty for well over 20 years and from the photos the nasal bones appear crooked and deviated. The best option for straightening these out is to perform osteotomies during the Rhinoplasty IMHO. Rasping the bone is limited to corrections just a mm or so due to the thickness of the nasa bones (perhaps 3-4 mm's thick). This amount of correction, in your case, does not appear adequate. In addition, if the nasal hump is removed, an open roof deformity will be created unless the nasal bones are broken and moved towards the midline to close that open roof. Hope this helps.
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After an injury, partial rhinoplasty rarely succeeds.
In my military and civilian experience with a lot of broken noses, I can tell you that, typically, there is usually more wrong than just a couple of bumps. If the nose is crooked, there is a good chance that the septum is deviated. You did not mention anything about breathing problems. Do you have them?
If the middle or lower portion of the nose is crooked, then it is probably not just a matter of the two bumps causing the crooked appearance.
My recommendation is that you have a second opinion with a surgeon who focuses and specializes in nasal surgery. You need a complete examination, including:
- Careful analysis of the interior of the nose to see how crooked that is
- If a breathing problem exists.
Do not dismiss the need to have the complete procedure because, generally, a "smaller" surgery will probably not be successful in terms of:
- Straightening the nose
- Giving you a nose with an appearance you like
Remember, you also have to figure in the dimension and shape of your tip. When you shave down the bumps, and perhaps reduce the profile, the tip of your nose may look more prominent.
So again, the most important thing is to "do a complete evaluation of the nose inside and outside" before you sign up for surgery.
Robert Kotler, MD, FACS
Facial Plastic Surgeon
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
Large Nasal Humps Need Osteotomies And Rasping
I think you will find that the simpler approach of rasping will leave you disappointed with your type of nose. To get an acceptable result, you need a complete approach to your dorsum including osteotomies and rasping. Rasping of the nasal bones is a good approach for a really small nasal hump that is largely bone. Your dorsum poses a bigger problem that warrants a more comprehensive approach.
You will probably need both rasping and osteotomies to get the nose to look good. If you jsut rasp you run the risk of having a very flat wide nose. But, it is difficult to say without an exam.
Polish or Complete Nasal Bone Correction
From your photos, it appears that osteotomies would be better for your overall correction. Polishing the bony irregularities may improve some issues, but will not completely straighten your nose. In the end, it is better to correct the underlying structure, rather than camouflage the issue, as long as the correction is a predictable one.
Osteotomies in the setting of nasal trauma are reasonably predictable and will help to improve your function as well. It will also more completely correct your contour problems, especially in the sidewalls of the upper nasal bone region.
All the best
Minimal nose surgery seldom works well.
Just going by your pictures, I don't think you will have a good result with just rasping. You may need a spreader graft on the left. In any case, recovery from a "full" rhinoplasty is not bad.
Rasping a Nose Bump VS a FULL Nose Surgery
It all depends on the look you wish to have at the end of the road. Unlike like threatening conditions, a nose job is NOT an operation you "MUST" have but an operation you "WANT" to have. Small operations commonly produce small or temporary results.
For example, the nasal deformity may be hidden temporarily with a long lasting filler. It will not really fix the problem but rapidly APPEAR to correct it for a year or so. The blow to the nose literally shited the whole nasal structure to the side. Only rasping the area will do NOTHING for an underlying cartilage deformity and exaggerate the width of the nose as well as unveil an underlying deviated septum. So - if you want a chance at a narrower, more centered and attractive nose you most likely would benefit from a full rhinoplasty as well as a possible correction of the septum.
Peter A Aldea, MD
Rhinoplasty and osteotomies
Of course, your exact surgical plan will need to be determined by the in-office exam. Given that, I perform a large amount of revision rhinoplasties. One of the most common causes for revision is inadequate treatment of the nasal dorsum. Almost certainly, you will need osteotomies. Simply shaving will not take care of your bump.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.