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Osteotomy for Symmetrical, Straight, but Fat Nose?

asked 2 years ago by erio in WA
Latest answer by William Portuese, MD
Question viewed 2,913 times
Tags: nose, fat

The front profile of my nose has fatty bone, bulbous tip, and wide nostrils, but symmetrical and straight. The side profile of my nose has a very small hump, but also has a perfect shape.

I met 3 surgeons for consultation on Rhinoplasty for reducing width of bone and nostrils. Surgeon 1 listened to my needs, suggested closed surgery, cut/stitch cartilage near tip, rasp bone, and reduce nostril flare. Surgeon 2 suggested open surgery, and the rest same as above. Surgeon 3 suggested open surgery, increase tip definition, columella-show with graft, nostril width reduction, no flare reduction, osteotomy/fracture bone at the base on both sides to reduce width.

When is rasping not good enough? Why should Osteotomy be done? Where are the cut bones reattached at the base?

8 answers to Osteotomy for Symmetrical, Straight, but Fat Nose?

Osteotomies will narrow a wide nasal bridge

Osteotomies are performed to narrow wide nasal bridges. Osteotomies are also done when a large hump has been removed from the nose and the surgeon needs to close the open roof deformity. If not, the nose bridge will be square and the patient will have a flattop nose after a hump reduction. Both medial and lateral osteotomies of nasal bones are usually performed to straighten and realign the nasal pyramid on the nose that has been broken or fractured.

William Portuese, MD
Seattle Facial Plastic Surgeon

www.seattlefacial.com

So many Rhinoplasty techniques out there--choice depends on your anatomy and goals

It can be confusing for a patient seeking rhinoplasty. So many methods and opinions exist which may vary surgeon to surgeon (as you discovered). Sounds like your goals are: to narrow the bones, lower the hump on the bridge, refine the tip, and narrow the nostrils. These are common goals but the appropriate techniques to use would depend on certain features of your anatomy. Without seeing pictures and having the luxury of a physical examination, it is tough to provide details about a plan... more

David W. Kim, MD
Bay Area Facial Plastic Surgeon

Rhinplasty Expectations

Rasping is a technique used to remove excess bone or cartilage. How much is removed from the bone will determine if osteomoties are necessary. You want to maintain continuity of the bones after surgery. Therefore, if a significant amount of bone is removed, it will be necessary to do the osteotomies to move the nasal bones to maintain continuity between them and the surrounding bones. This will heal like any fracture. You have done your homework; now decide what you want to change and... more

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon

Rhinoplasty

Rasping of a dorsal hump is very common. When this is performed, usually you get an "open roof" which is a flattening and a wider appearance of the upper 1/3 of the nose. The osteotomies close this "open roof" and allow you to have a narrower look to your nose. So when it appears very flat after rasping, osteotomies are necessary. The bones are not usually cut all the way, but are allowed to "greenstick" or incompletely break so they narrow but still stay... more

Steven Wallach, MD
Manhattan Plastic Surgeon

Rhinoplasty Osteotomies, When is Rasping Enough?

Hi Eric, Lot's of questions, lot's of consults, that's good. Rasping is a method to reduce nasal bone height in a graduated fashion. The nasal dorsum may be reduced either with rasping or by using a chisel. Osteotomies are performed to narrow the upper 1/3 of the nose (the boney portion), and/or to close the "open roof" that is left when a large dorsal hump of bone is removed. The cut bones reattach very near to where they were cut, they are just angled more toward the dorsum of... more

Michael A. Persky, MD
Los Angeles Facial Plastic Surgeon

Osteotomies in rhinoplasty

There are many components to rhinoplasty, as well as different methods of doing it. Open vs. closed approach is sometimes just a surgeon's preference. You can ask your doctors whether they do both approaches, and how often, and most importanly see their results and make sure you like them. Sounds like you are getting enough information. Osteotomy is a fancy word for cutting the bones. You mention that your "front profile" has "fatty bone". I presume it means your... more

Stella Desyatnikova, MD
Seattle Facial Plastic Surgeon

Rhinoplasty and The Bones

Rasping is what is done to take down the bony hump. Osteotomy is completely separate procedure and the other doctors probably failed to mention it. The breaking of the nose at the base where it meets your face of cheeks is commonly necessary when a hump is taken down. It may not be necessary when the hump is very small, but more often it is required. What the rasping does is given you what is called an open roof. If you imagine a triangular roof on top of a house. If you take down the... more

Farbod Esmailian, MD
Orange County Plastic Surgeon

Cutting bone during Rhinoplasty

Interesting set of opinions demonstrating that rhinoplasty is perhaps the trickiest operation is all of aesthetic surgery. In general (and without the benefit of your picture) the base of the nasal pyramid should sit within a line drawn from the inside of the eyelid to the corner of the mouth. The width of the pyramid is established by the relationship of the bones of the nose merging with the cheek bone. If the pyramid is too wide, an instrument called an osteotome is used to cut the... more

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon

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