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Opinions on Breaking Nasal Bone Technique?

asked 3 years ago by cannqua in fort wayne
Latest answer by Thomas Buonassisi, MD
Question viewed 821 times
Tags: nose, scar

My son has a small dorsal hump on his nose. We consulted with a plastic surgeon and he stated he could file down the hump, and that he would then break the bones on either side of his nose to prevent the nose from looking too wide. His approach to breaking these bones is to make a small 1-2mm incision on the outside of the nose on both sides. He said this would cause minimal scarring. From what I researched the nasal bone breaking is usually done from the inside. What do you think of this approach?

14 answers to Opinions on Breaking Nasal Bone Technique?

Both techniques can be used.

The skill of the surgeon is more important than how he does the osteotomies. Having said that, in more than 30 years of rhinoplasty surgery, I have never found the need to make an exposed scar when I can do the same thing inside the nose without any chance of a noticeable scar.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon

www.bevhills.com

Percutaneous osteotomy great for gentle and accurate nasal bone fractures

What your surgeon is recommending is a percutaneous osteotomy. This is an excellent technique for making gentle and very accurate fractures in the lateral portion of the nasal bones. This would be a common technique used to narrow the bridge after a hump is reduced. In some cases the osteotmies are performed from within then nose. It depends on the thickness of the bones and the degree of nasal bone movement required. Most Rhinoplasty specialists use various osteotomy techniques... more

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon

www.8west.ca

Surgically Breaking the Nasal Bones -- Osteotomies

Different surgeons utilize different techiques, but one is not better than the other. The basic premise of surgically breaking the nasal bones (called osteotomies) is that a delicate instrument is used to cut the bones under the skin. The surgeon then repositions them to acheive the desired result. Osteotomies are performed during rhinoplasty for several reasons. Narrowing a wide bridge (top of nose): One of the most common reasons for surgically breaking the nose is to narrow the... more

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon

www.rhinoplasty-usa.com

No need for external incisions

The osteotomies are normally performed completely on the inside of the nose. There is no reason to make an external incision 2 mm on each side to narrow the sidewalls of the nose. If the bump is quite small on the bridge of the nose, no osteotomies need to be performed. If the bump is significant enough, osteotomies will be performed in most rhinoplasties. These are performed through an endonasal approach narrowing the nasal bones to give further fit and balance to the nose. If the... more

William Portuese, MD
Seattle Facial Plastic Surgeon

www.seattlefacial.com

Breaking Nasal Bones

Internal and external techniques for fracturing the nasal bones are acceptable. Individual surgeons have their own preferences. Share your concerns with your docter. If you're still not satsified, get a second opinion.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon

I prefer the external osteotomy.

While there is no specific approach that is "better," I tend to prefer the external osteotomy (a post-stamp perforation of the bones through a 2mm stab incision of the nasal skin). Scarring from this approach is essentially a non-issue since they tend to heal with near invisibility. This approach minimizes bleeding and trauma to the delicate lining tissues of the nose. It also, in my opinion, maintains better stability of the nasal bones by tearing up less periosteum (the lining... more

David C. Pearson, MD
Jacksonville Facial Plastic Surgeon

External versus internal osteotomies

Breaking of the nasal bones is commonly done externally, although internal osteotomies are still preferred by some surgeons. I prefer external osteotomies as I feel they offer more precision and less bleeding and bruising than internal. Some surgeons may do both, but it is usually best to allow the surgeon to stay within his comfort zone - the procedure he performs most often will usually yield the best results in his hands.

W. Tracy Hankins, MD
Las Vegas Plastic Surgeon

Osteotomies in rhinoplasty

There are many ways to perform osteotomies. In fact, the way that your doctor describes is my preferred technique. In fact, I do it so frequently without any long term visible marks, that I usually forget to discuss the types of osteotomies with my patients. There have been a few studies that suggest that this approach causes less internal bleeding and tearing of the internal lining.

Steven Wallach, MD
Manhattan Plastic Surgeon

Many options in rhinoplasty surgery

It never hurts to research your options and to ask probing questions. There are no absolutely right or wrong ways to perform any surgical procedure. If there was only one right way to do the surgery then everyone would do it the one 'right way'. There are several ways to perform a lateral osteotomy. I have found that the external approach is the least traumatic and most precise method. Others will, of course, debate this option. Precision, control and avoiding bruising are keys to... more

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon

Discuss with your surgeon

Both internal or external approaches may be used for the osteotomy. Like most things in plastic surgery, there are pro's and con's to each approach. Many plastic surgeons have switched over to the external approach because of some advantages it offers. I am sure your surgeon can do either technique and I would discuss the options with them.

Dean Fardo, MD
Atlanta Plastic Surgeon

How to deal with a dorsal hump on the nose.

If the hump is small, as you describe, your son might benefit from a Non-Surgical Rhinoplasty. This is where injectable filler is placed above and below the hump creating a straight appearance. I've done this in male patients, and I attached a link to my Non-Surgical Rhinoplasty page which demonstrates photos of this exact scenario for your perusal. As a facial plastic surgeon, most of the nasal procedures I perform are surgical. There is no right or wrong way to deal with a hump, as long... more

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon

www.ericmjoseph.com

Techniques for Osteotomies

You are describing the percutaneous lateral osteotomy technique which is used by some surgeons. It is true that the (usually) 2mm incision heals up so well that it is often difficult to find any scar. Personally, I prefer to cut the bones through the endonasal approach. At the end this comes down to surgeon preference and experience. What ever gets the job done in a controlled fashion is acceptable.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon

www.drfechner.com

Rhinoplasty; What is Best Approach to Cut the Bones?

Hi Cannqua, There are different approaches to accomplish osteotomies (cutting the nasal bones) during rhinoplasty. Using a mini-chisel externally creates a 1 to 2 millimeter incision that heals very well and is usually not noticeable. More important than the approach to osteotomies is your trust that your surgeon does excellent work. Good luck and I hope that both you and your son are very pleased with his new nose. Dr. P

Michael A. Persky, MD
Los Angeles Facial Plastic Surgeon

Techniques for osteotomies

There are many techniques used for osteotomies during rhinoplasty, and it really comes down to surgeon preference. While I prefer to use an internal approach, the external approach you are describing is well documented in the literature and is one of the standard techniques. (It is very direct and allows for good control of the osteotomy position.) I would not suggest that you attempt to coerce your surgeon to use some technique that they do not routinely use, as you may end up with a... more