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How Do Doctors Decide When To Do a Rhinoplasty With Oesteotomy or No Oesteotomy? (photo)

I had my rhinoplasty done in Thailand to de-hump and improve the tip. My humps are still clearly visible especially at 45 degree views. My surgeon didn’t perform an oesteotomy. When I asked why? He explained after that because I’m biracial half asian-caucasian I did’t needed an oesteotomy because of the smaller and thinner humps than caucasians. Instead he overasped and now I have an inverted V-deformityWhen is an oesteotomy necessary and when is it not? How do I get rid of these side humps?

Doctor Answers 9

Your nose needs otseotomies

Based on your photos it appears that you could benefit from a revision which would involve building tip support, minor hump refinement and osteotomies

Seattle Facial Plastic Surgeon
5.0 out of 5 stars 172 reviews

1110 112th Ave NE
Bellevue, WA 98004

Nasal Hump Removal with with No Osteotomy

Regardless of ethnic background, removal of a hump without osteotomies can cause a flat bridge with an open roof deformity (your side humps). Nasal fractures (osteotomies) are usually necessary  but can be performed with a revision procedure. The inverted V deformity should be corrected with cartilage grafts at the same time. This will also improve nasal breathing.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 22 reviews

416 N Bedford Dr
Beverly Hills, CA 90210

When is osteotomy needed?

When a hump is removed and leave aside flat open space ("open roof") between the bones they need to be narrowed with an osteotomy.  You appear to have multiple issues occurring including deviation, middle vault collapse and residual hump. You will need more done then just osteotomy. Good luck!

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

1515 North Flagler Dr.
West Palm Beach, FL 33401

Hump removal

When taking down a dorsal hump the bones dorsum looks flat and wide.  Osteotomies narrow the bones and improve the appearance of the flattened dorsum from rasping.

Steven Wallach, MD
New York Plastic Surgeon
4.5 out of 5 stars 20 reviews

1049 Fifth Ave
New York, NY 10028

Why the osteotomy in rhinoplasty

When the hump is removed the bridge will have a flat spot and sometimes an open roof where the edges of the nasal bone and the septum can become visible. The osteotomy helps close the bridge as well as narrow the bridge if needed. The inverted V you have can be corrrected by the osteotomy and a spreader graft to fill and hold the space in the bridge if you are unhappy with the result you have.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 36 reviews

8901 West Golf Road
Des Plaines, IL 60016

How Do Doctors Decide When To Do a Rhinoplasty With Oesteotomy or No Oesteotomy?

  This is a rather simple decision and is based upon the amount of dorsal hump (bone) that's removed.  In your particular case, the dorsal hump is greater than the 1.5 mm or so thickness of the dorsal bone.  When removed, an open roof deformity would occur requiring lateral osteotomies to close this along the upper edges of the nasal bones during Rhinoplasty.  Osteotomies can also be recommeded to straighten crooked or deflected nasal bones back to the midline on one or both sides.  

  Knowing when this is required is part of understanding and following the proper aesthetics of facial (and nasal) beauty for the creation of a naturally, more attractive nose and face.  Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

8500 Wilshire Blvd
Beverly Hills, CA 90211

Too bad you had incomplete incompetent surgery.

You need to have the surgery re done by a qualified plastic surgeon who will do what is needed. Unfortunetly a lot of surgeons out of the country are really not qualified to do what they do. There is no simple answer to your question, but 30 years of experience in doing noses allows me to know when to do what is needed.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.0 out of 5 stars 10 reviews

308 E 79th St
New York, NY 10075

Osteotomy or not

Usually with a significant hump reduction an osteotomy is necessary to close the open book deformity left with the reduction.  There are a few instances where the nose is already very narrow and the hump reduction is minimal where the osteotomies are not needed.  Also cases where no hump is reduced and only tip work is done may not require osteotomies.  Every case is different.  Donald R. Nunn MD  Atlanta Plastic Surgeon.

Donald Nunn, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 17 reviews

5673 Peachtree Dunwoody Rd NE
Atlanta, GA 30342-5029

Nasal Hump


It looks like you still need a hump reduction. Your hump was not fully reduced. If you reduce your hump you may need osteotomies to prevent an open roof deformity. Whether you have an osteotomy or not has nothing to do with your ethnicity. Osteotomies are performed to narrow the nasal bridge and avoid open roof deformities.



Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
5.0 out of 5 stars 235 reviews

44 East 65th Street
New York, NY 10021

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.