Rhinoplasty: Q&A
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Will my Doctor Break my Nose During a Rhinoplasty?
my greatest fear of a nose job is the doctor snapping my nose. Thats not urban legend is it, that doctors break your nose during nose surgery?
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65 Doctor Answers |
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anon
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Reason to break the nasal bones during rhinoplasty
Many people are concerned that they will have their nasal bones fractured during rhinoplasty. So, why would this need to be done in some cases and not in others? The simple answer is that when taking down a nasal hump, it is important to narrowing the nasal bones in order the close the "open roof" created during hump reduction. Without this step the nose will appear too wide. The other general reason is to straighten the nose when it is crooked. When tip work is...
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Breaking the Nasal Bones
Depending on what is being done to reshape the nose, it may be necessary to break the nasal bones.
This is done with special bone cutting instruments for precision.
Of course, you would be unaware of what is happening during surgery with sedation or anesthesia to allow you to sleep through the entire procedure.
The pain from the breaking of the bones is similar to a very mild headache.
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Breaking of the nose (osteotomy) during rhinoplasty
No, it’s not an “urban legend” although we don’t call it snapping the nose, but rather osteotomies. It is not always indicated, and can be avoided in some cases when just rasping or filing of the walls of the nasal bridge are adequate, but for many cases especially when a bump is taken down or the bridge is very wide, osteotomies are an essential component of rhinoplasty.
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To reshape the nose "breaking bones" may be needed
To reshape the nose in many cases the nasal bones and nasal wall may need to be repositioned. This is accomplished with surgical cutting instruments to make precise cuts to reposition the nose. It is not severely painful and if needed the surgeon will give the patient some form of pain relief to minimize the discomfort.
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Rhinoplasty, Narrowing the Nasal Bones or Breaking the Nasal Bones
Rhinoplasty is an art and oftentimes a veriety of techniques are used to get the best aesthetic outocome.
Breaking the bones is not done in all rhinoplasty patients. Often times, reshaping of the bones are performed without breaking the bones by special instruments.
The technique of Osteotomies or controlled narrowing of the nasal bones is common aspect of rhinoplasty procedures. This portion of the procedure can be fairly painless.
This technique is routinely used...
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Everyone is afraid of nose breaking during rhinoplasty
There hasn't been a patient that isn't afraid of what happens during rhinoplasty when it comes to breaking the nose. The image of a doctor breaking the nose with a hammer is far from reality. In fact, carefully cutting the nasal bones with a fine osteotome, or chisel, during rhinoplasty is a common maneuver with predictable results. I use a 2 mm wide osteotome (about one-tenth of an inch) and precisely cut the bones where narrowing is needed. This is...
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Manhattan Facial Plastic Surgeon
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Osteotomies (Surgically Breaking the Nose) and Rhinoplasty
Because each nose is unique, every rhinoplasty should be approached on an individual basis. The need for osteotomies (surgically breaking the nose) will depend on the type of the nasal deformity and the goals for surgery.
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...
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Rhinoplasty is one of the most difficult facial plastic...
Rhinoplasty is one of the most difficult facial plastic surgical procedures to master. Osteotomies are one of the more difficult maneuvers to understand in rhinoplasty. Having written several papers and chapters on this topic, and having taught this to other surgeons in the cadaver lab during my Facial Plastic Surgery Course, I can tell you these statements are absolutely true.
The indications for breaking the bones of the nose are (not all-inclusive):
•to close the top of the nose when...
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Breaking the bones of the nose, or osteotomies, are...
Breaking the bones of the nose, or osteotomies, are oftentimes done in a precise, controlled fashion in order to narrow the width of the bridge of the nose during rhinoplasty.
This maneuver is quite common in rhinoplasty surgery and can produce a nice change or refinement in a nose that looks too big or wide on the face.
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Will my Doctor Break my Nose During a Rhinoplasty
The osteotomy (breaking of the bones) may not occur with your surgery. This is used when a large hump has been taken down leaving a large flat surface. When an osteotomy is done it is done with very fine movements and delicate cuts to improve the shape of your nose.
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Breaking the Nasal Bones
Depending on the scope of the surgery, it may be necessary to break the nasal bones. While the thought is unnerving for some, the actual process is precise and the pain involved is mild.
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Does the nose have to be broken during rhinoplasty?
Breaking the nasal bones, or controlled infracturing, during rhinoplasty is a delicate and refined technique to narrow the bridge of the nose. If a large hump is taken down, the bridge may look like the top of an aircraft carrier. The nasal bones then need to be brought in to round off the edges. This creates a more refined and natural appearance.
see video
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Rebreaking the nose in a controlled fashion may be necessary.
Doctors do oftentimes during rhinoplasty break the nose in a very controlled fashion. While this takes a great deal of skill to do it appropriately and in a constructed manner you shouldn’t be fearful of having this done. Re-breaking the nose can allow the surgeon to straighten the nose as well as to make it smaller. In addition, with the controlled techniques that we use today, patients typically do not have a lot of discomfort after having rhinoplasty which includes breaking the nose...
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Breaking the Nose In Rhinoplasty
It is considered an urban legend that whenever a patient has a rhinoplasty that the nose is “broken”. However, that is not necessarily true. It depends on whether this needs to be performed to improve nasal appearance or to correct nasal deviation. In my practice, about half of the time the nasal bones are not fractured or broken as part of a rhinoplasty. It depends on the analysis of the patient’s problem and what is needed to optimize the result for cosmetic improvement...
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Rhinoplasty
Rhinoplasty involves multiple steps and not all the same for each individual patient. If a bump on the top of the nose needs to be taken down, then the nasal bones often have to be infractured, or carefully cut so that the bones can slide in and leave the desired nasal appearance both by narrowing the nose and correcting the "lines" of the front appearance.
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Rhinoplasty and What is Involved
The purpose of a preoperative consultation is to make sure that your and your Surgeon are on the same page as far as your goals. Assuming your goals are realistic, a good Rhinoplasty Surgeon will be able to employ a range of techniques to achieve a result you will both be pleased with. Breaking the nasal bones, or osteotomies, are sometimes necessary in order to accomplish the aesthetic result desired; in fact, failure to perform osteotomies is sometimes a mistake. The...
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Nose job: Types of Fractures or bone cuts
The use and type of fractures in nose job depend on the goals to be achieved. Sometimes no fractures (we call them osteotomy = bone cuts). Occasionally we use one fracture on one side of the and different type of the other side. They are used to push bones in or to push them out. Sometimes the bones are completely cut and shifted and other times they are perforated like a sheet of paper and partially attached (greenstick fracture)
see video
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Nasal Bone Management During Rhinoplasty
Although the nasal bones may be "cut" (osteotomized) and repositioned during rhinoplasty, I don't think any of us would use the term "snap" or "break" to describe what is really a meticulous maneuver to create the most aesthetically pleasing nose possible. Keep in mind that not every nose requires modification of the nasal bones. Typically, those that are wide, crooked, have post-traumatic deformities, or require modification for airway...
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Your surgeon will never "break" your nose during rhinoplasty
The nasal bones are precisely and delicately "cut" during rhinoplasty for one of two reasons. The first, your nose is deviated (crooked) and your bones must be cut and re-set in the middle. The second, you had a bump that was removed leaving an opening in the "roof" of the nose and the bones are cut to close that roof. These is a very precise and controlled procedure and should not be confused with "breaking the nose."
Best,
Dr. Stephen Weber
Lone Tree Facial Plastic Surgeon
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Your nose may get broken during Rhinoplasty
Your nasal bones may or may not be broken during a rhinoplasty. Fracturing the nasal bones is necessary, if they are crooked to start with, or if a large hump is taken down. Relax however. This is very different from you breaking your nose in a sports injury for example. First of all you will be completely anesthetized so you don't feel anything. Secondly, this is a controlled break rather than a whack on the face. You really should not worry about...
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Breaking the nose during rhinoplasty: It's more finesse!
As seen from the front, the nose should not look like a sausage, it should widen at the top and bottom and taper in the middle (like an hourglass). In order to achieve that type of harmony between the upper and lower parts of the nose, your surgeon may need to manipulate the nasal bones.
Through small incisions, precision cuts are made in the bones in order to free them and allow the nasal bridge to be narrowed or widened. Remember, the nasal bones are not...
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Breaking the nose during rhinoplasty
The rhinoplasty procedure involves reshaping the nasal skeleton, which is made of cartilage and bone. After the hump is brought down (which is both cartilage and bone), the sides of the nose must be narrowed. This is done by performin osteotomies, which are basically cuts on the bone. This is necessary to give the nose a balanced and proportioned look. You should not be afraid of this, as this does not cause any pain durring or after the procedure.
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Management of Nasal Bones During Rhinoplasty
The nasal bones are often repositioned during rhinoplasty to close the "open roof" after lowering a "dorsal hump" and to narrow the nose slightly. Repositioning bones involves very controlled fractures, but this is a necessity if you want a narrower nose. If under general anesthesia, you don't see it, hear it, feel it, and afterward, you'll never realize it has been done.
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Possible need to break nasal bones during rhinoplasty
Depending on what maneuvers are performed to reshape your nose controlled bone fractures (osteotomies) may be needed during your surgery. Common indications are:
The nasal bones (the upper 1/3 of your nose) are deviated or excessively wide.
You have a hump on your bridge that you want removed. Your surgery will need to shift the nasal bones inward after this to avoid leaving you with what's called an open roof deformity (i.e., an excessively flat, wide...
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Breaking of the bone with rhinoplasty
An osteotomy is sometimes performed during rhinoplasty to narrow the bridge of the nose. It does not have to be performed during every surgery, however, it is almost vital in some cases. Discuss this with your surgeon, as it is an important element in some rhinoplasties.
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Handling the nasal bones in rhinoplasty
The vast majority of patients who undergo rhinoplasty to change the way their nose looks are ultimately extremely pleased with their result, regardless of whether the nasal bones are "broken" or not. This question is an extremely common one asked by patients considering rhinoplasty for a number of reasons. Patients fear it will be very painful and cause them to have black eyes. Many of them have watched rhinoplasty videos on YouTube and found the process of...
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Rhinoplasty Terminology- "Breaking the nose"
Many patients are haunted by the phrase, "breaking the nose." I get asked this questions very often during my rhinoplasty consult.
When referring to this, most people are referring to a procedure called an osteotomy. An osteotomy is performed only in SOME rhinoplasties in order to narrow the bridge of the nose. This is a controlled fracture of the nasal bones, which are very thin and comprise the upper one-third of the nose. The term "breaking the...
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Your surgeon may break your bones during rhinoplasty if....
There are many reasons why your nasal bones may be broken if you have a rhinoplasty. Here are the most common reasons:
if a large hump is removed from the bridge, you may end up having the edges of the nasal bones no longer touching at the midline, resulting in a wide, flat bridge (this is called an 'open roof''); breaking and repositioning the bones will correct this problem
your nasal bones are wide, and bringing them closer together will make your nose more...
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Breaking the Nose During Rhinoplasty
Breaking the nose during rhinoplasty is not what you imagine. It is a controlled weakening of bones of the nose. This may be necessary to narrow the width of the nose to produce a pleasing result.
Dr. ES
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3 Reasons a doctor may have to break your nose during rhinoplasty.
The idea of a nose break is pretty scary to most people. The truth is it's even a little daunting to young surgeon's first learning to do rhinoplasty. During the surgery, the nose break (osteotomy) is a time where the anesthesiologists, and sometimes the nurses look away.
The good news is, making breaks in the nasal bones does not hurt during the procedure because the patient is under general anesthesia. Making the breaks in the bone, like all the steps...
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Is breaking the nose necessary for every rhinoplasty?
"Breaking the nose" is the lay term for "osteotomies" - delicately cutting/freeing the nasal bones to achieve appropriate proportions between the upper and lower part of the nose. Osteotomies can also close an "open roof" from removing a large hump or straighten a crooked or previously broken nose. While not necessary in every rhinoplasty, most noses benefit from these osteotomies. While I will tell certain patients they may not need osteotomies - and I will try...
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Breaking your Nose...
Yes, surgeons "break" your nose....but using the word "break" implies out of control trauma to the area. We as plastic surgeons and especially those of us who do nose surgery make sure the bones are "fractured" using controlled "osteotomies". These osteotomies come in many varieties according to what needs to be done to your nose to decrease its width. Control and precision is key in rhinoplasty to ensure consistently predictable results.
Hope this...
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Nasal fracture as part of rhinoplasty
We may try and use euphemisms in describing a rhinoplsty but the reality is, yes, we do fracture the nose in the majority of aesthetic nasal surgery. The bones on the side of the nose are fractured with a chisel to move them toward the middle and create a more narrow and refined look. This is typically done in conjunction with refinement of tip structures and removing any hump that is prominent.
Best,
Tal Raine MD
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Rhinoplasty and nasal bones
It is rather common in my practice for patients to ask questions about "breaking the bones" of the nose. In reality the nasal bones are not broken during nasal surgery. In some patients I perform re-contouring of nasal bridge to achieve better balance, or to straighten the nose. In those cases I manipulate the nasal bones with special instruments. Even thought this maneuver can cause some bruising in reality in is virtually painless. For most...
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Osteotomy - if it's needed, you want it
Nasal bones are "broken" in a delicate and precise fashion. We call this an osteotomy or cutting of the bone. It is needed if:
1) a hump is removed
2) The nose is crooked and needs to be straightened
or
3) If the nasal bones are wide and the patient desires for them to be narrowed,
Although this sounds scary - if your surgeon is experienced in rhinoplasty there is nothing to worry about!
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Bones are reshaped during rhinoplasty
Most patients are worried about their nasal bones being "broken" during a rhinoplasty. Usually, if the goal is to straighten a crooked nose or narrow the upper 1/3 of the nose, then yes, the nasal bones have to be repositioned. This involves precise cuts in the bone and then they're reshaped accordingly. I tell patients not to worry about technical details of this or any other surgery and instead focus on their aesthetic and medical goals.
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Rhinoplasty does not need "breaking" of the nose but a controlled shaping of the nose to be effective
Rhinoplasty does not need "breaking" of the nose but a controlled shaping of the nose to be effective. It is all in the way that you say things I would say. Breaking the nose sounds very uncontrolled and unrefined. Rhinoplasty couldn't be further from this. This procedure is the most intricate and detailed that a plastic surgeon can do. The nasal bones often have to be shaped to take on the new form. And breaking is not accurately used to...
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Nose "breaking" during Rhinoplasty?
When someone speaks of “breaking” a nose, they are usually referring to the boney portion of the nose. In fact, only the upper one third to one half of the nose involves the nasal bones. If any reduction or straightening of the nasal dorsum (the top of the nose) is required, bone work will likely be involved. However, very precise instruments are used so that the nasal bones are cut, rather than “broken”. So, breaking the nose during nasal surgery is not urban legend....
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Nose jobs involve more elegant act than "breaking" the nose
Both doctors and patients often use the term "breaking the nose" to describe one of the steps of a rhinoplasty. What actually happens is that a special instrument called an osteotome is used to make a cut through the bone in such a way that the nasal bones can be pushed closer together after the removal of the "hump." It is a more controlled maneuver than what is implied in the term "breaking" the nose.
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A controlled osteotomy is often performed during rhinoplasty
A controlled osteotomy or 'breaking of the nose' is often performed during rhinoplasty in order to achieve the proper aesthetic result. You should not worry about this as this is a common procedure used and in itself is not a painful aspect of the procedure. You should allow your surgeon to use the techniques that are necessary to help him or her achieve the best aesthetic result possible.
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Rhinoplasty is a popular and effective surgery to recontour the shape of your nose.
In patients who request the adjustment of the middle portion of their nose or to make their nose less wide, it may be necessary to move their nasal bones with a controlled fracture. Although some people call this breaking the nose this process weakens the bones enough so that we can move them and is very controlled.
Keep in mind that even small changes to your nose can create a dramatic change in your overall appearance. For this reason, it is essential that you work with a...
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Breaking nose during rhinoplasty
Don't be afraid! Your nose is not broken or snapped in the usual sense during a rhinoplasty. If the bones need re-positioning, then careful cuts will be made to allow them to move. You will be under anesthesia and not feel anything or be aware of what is done. Afterwords, there usually is very little discomfort. Be sure to discuss any fears you have with your surgeon.
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Need for osteotomies (seperating nasal bones) during Rhinoplasty
This is a common concern of many undergoing nasal surgery. As many have stated, your surgeon does not "break" the nasal bones. Your surgeon may carefully seperate your nasal bones with a special instrument called an osteotome. This manuver is called "osteotomies". Not all patients need osteotomies. If, however, you have a large nasal hump or a wide nasal bridge your surgeon will likely need to perform this manuver. Explain any...
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Yes and no.
Your bones are often 'broken' during rhinoplasty. However many times this isn't necessary. And when it is needed, the nasal bones are broken in the sense they are randomly fractured. Your surgeon carefully makes cuts in the bones so they can be moved slowly and accurately to a better position.
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Rhinoplasty Cuts, not "Breaks" Bones
There is a common misconception that a surgeon "breaks" your bones during a rhinoplasty. To make an analogy, think of a carpenter, the carpenter would never be spoken of as "breaking" wood (at least not a good one!).
If the bony parts of your nose need to have the shape changed, there is really no other option but to cut and move the bones. It is done with special instruments designed to make precise clean cuts. As I do it, you are soundly sleeping under deep sedation and...
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Breaking the Nose During Rhinoplasty
Rest assured, any reputable rhinoplasty surgeon would have a lengthy discussion with you preoperatively if they were going to break your nose. What many people refer to as 'breaking the nose' actually refers to a maneuver called an 'osteotomy' that involves very precise cutting used during surgery.
Most osteotomies are done to narrow the nose to create a more defined frontal shadow. They are also used commonly to straighten a crooked nose deformity. Most experienced...
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Breaking Nose During Rhinoplasty
Osteotomies (surgically breaking the nasal bones) is not done in all rhinoplasties. It depends on what is necessary to improve your appearance. You will know before surgery if this will be necessary. Don't fear this maneuver; with good anesthesia you will be unaware.
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Nose Breaking (Osteotomy) during a Nose Job (Rhinoplasty)
A Nose Job (Rhinoplasty) is a sculpting procedure. In order to shape the height and width of the nose, the nose may have to be broken in very precise directional fractures (called OSTEOTOMIES) along the side (LATERAL) or the top (DORSAL) of the nose. These controlled fractures fractures are usually done from inside the nose or through a small opening along the side skin. In the vast majority of cases these heal beautifully and are not anything you should worry about.
Dr. P. Aldea
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Breaking the nose during rhinoplasty
Breaking the nasal bones (osteotomies) during rhinoplasty allows narrowing of the bridge of the nose. It is routinely performed when a large hump is removed from the dorsum. If you have a large hump, you are likely to need osteotomies.
You are not unique in fearing this part of the procedure. During the actual procedure, you will not feel this maneuver, and you will not remember it after the operation. So don't allow this fear to consume you.
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Do you have to break my nose?
Breaking the nose or performing an osteotomy is almost a routine part of nose surgery. It is rare that I do not have to perform osteotomies during the procedure. The reason that nose surgery requires osteotomies is to narrow and shape the nose. After the hump is removed or the tip is narrowed the bones need to be narrowed as well. Every part of the nose is interrelated and must be treated accordingly.
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Rhinoplasty doesn't necessarily require your nose to be snapped
In general, every technique in rhinoplasty is only done if you want your nose to be narrower on the upper third, or if it is shaven down on the dorsum so much that it needs to bring together the sides. Not every rhinoplasty needs it, but when it is needed you definitely don't want to find out when it's too late. If your plastic surgeon recommends it, I wouldn't skimp on something like that.
Best Wishes,
DoctorMeade
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Breaking the nose during a rhinoplasty
I hate the term breaking, because the bones are actually cut and moved. This can actually be done rather gently. Because patients are most often under conscious sedation (or rarely completely asleep), they do not remember the experience. And it does not contribute to additonal pain postoperatively. If your plastic surgeon deems the procedure necessary, you should take his or her advice; even though it can sometimes be avoided completely.
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Breaking Bones in Rhinoplasty
Based on proper and extensive pre-operative analysis of your nose, your surgeon will determine whether an osteotomy (nose break) is needed or not. This depends on how wide the shadows and lines that cme from your eyebrows down to your tip are. Measurments and close evaluation of your photos will dictate the need for bone manipulation. Trust your surgeon and make sure you go to a surgeon who really "knows noses."
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Rhinoplasty may require cutting the bones
Depending on your anatomy and your goals, osteotomies (or controlled cutting of the bones) may be required to achieve the desired results during a rhinoplasty.
Often, if a hump is taken down, an open roof deformity results ("gap on top of your nose") which must be narrowed. This will also require osteotomies. Breaking the bones is a crude term and does not accurately describe what we do.
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Breaking nasal bones during rhinoplasty sounds much worse than it actually is
Breaking the patient's nasal bones during rhinoplasty is often a necessary component of the operation. However, in those patients who need only a tip refinement this can be accomplished without any bony work. Incidentally, in theses cases there is no post-op bruising. There are generally two circumstances that lead to the need for the surgeon to fracture your nasal bones.The first occurs when the nasal profile is being straightened by reducing a hump. After the hump is essentially shaved...
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Refining the nasal bone contour is important in most cosmetic rhinoplasties
Alteration of the nasal bone contour is frequently a necessary step in cosmetic rhinoplasty in order to refine the appearance of the nose. Don't think of it as "breaking" the nose because it's really an osteotomy. We take a special instrument that cuts the bone with surgical and artistic precsion and modify the bone contour in a very controlled fashion. "Breaking the bones" sounds too brutish, and in fact is inacurate.
As an aside, there are also rhinoplasty operations...
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It depends upon whether you need it or not.
Infracturing the nose is done to narrow the base (the bottom of the pyramid that is attached to the facial bones. This is usually an operative decision although pre-op evaluation can generally make a good prediction as to whether that maneuver will be performed. I find computer imaging very useful for the patient.
http://www.zubowicz.com/subpag,25-atlanta-rhinoplasty.htm
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Breaking the nose is a common part of rhinoplasty
Breaking the nose is such a harsh term!
How about narrowing the nose? This sounds better, doesn't it?
Most patients seeking rhinoplasty have a large hump on their nose and have large tips. The hump of the nose is similar to a pyramid. What happens when one shaves the hump (the top of the pyramid) down? The rest of the nose (pyramid) will appear wider. Therefore, it is necessary to narrow the nasal bones to make the nose balanced. Yes, this is done by making small breaks in the base of...
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Breaking the nose is a common part of nose surgery but it is not as bad as you think
If there is going to be any work done to reduce a bump of the nose or narrow the nose it is common to break the nose during the surgery. However, this is very different than the broken nose that results from an accident. Cuts are made to the bone to create precise movement which is well controlled by the doctor. You should not feel anything if you are completely asleep during the surgery and there is supriasingly minimal pain afterwards as well.
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Breaking of the Nose
Hi,
Breaking of the nose also known as "osteotomies" in medical terms is done to either narrow the nasal bridge or reduce a hump. I like to think of it as a controlled bone cut with very sharp instrument.
I'm not sure where that term came from but can only imagine. When rhinoplasty was first performed it is possible that the use of unsharp instruments led to 'breaking of the nose".
Now with use of very sharp instruments, nasal bones can be "cut". The comparison is:...
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Will my nose be broken during a rhinoplasty?
Not necessarily. Most rhinoplasties do require breaking the nose. The ones that don't are ones in which the tip is the only unattractive part of the nose and it can be done alone. Most rhinoplasties in which a hump is removed will require breaking of the bones.
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Don't even think about it!
If you are committed to a plastic surgeon, you need to be confident that they will do the right thing. I do the surgery with the patient either sedated or completely asleep and the nose is numbed with local anesthesia. If I must break the nose to give you the proper result , then I will. It does not hurt and you don't even know that it was broken after the surgery.
You must have confidence in your surgeon and understand the proceure. There is nothing to be afraid of.
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To break or not to break
To break or not to break the nose really depends on what aesthetic goals you are trying to achieve. For smaller profile changes you may not want to narrow the nose with osteotomies. Rasping the nose and reshaping the nose may be all that is necessary. While breaking the nose does sound like the scariest part of the operation, if done properly will add very little swelling, bruising, pain, and recovery time to your procedure and may be necessary to give your nose the proper alignment and look.
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Breaking the nose is not a big deal!
Osteotomies (term used for breaking and repositioning of nasal bones in rhinoplasty) is actually one of the more simple maneuvers in rhinoplasty and does not necessarily correlate to an increase in pain although it does cause more bruising.
The nose will not need to be broken if you are having rhinoplasty to:
Make subtle changes to the tip
Make subtle changes to the bridge
Reshape a wide and flat nose (African, Southeast Asian, or Latin American noses)
The nose will likely need to be...
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In most but not all rhinoplasties a surgeon does make...
In most but not all rhinoplasties a surgeon does make some very controlled cuts in the nasal bones and narrow them to correspond with the narrowing of the middle third of the nose and the tip. A cast is then applied across the bridge to hold the new nasal bones in the new shape.
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