How to Fix Wide Nasal Bone After Rhinoplasty?

Question

I had a nose job 12 months ago and my sides of my nose at the top look like bones sticking out, can this be fixed? If so how? I can send you more pictures if needed.

C. Spencer Cochran, MD · Answer

Correction of wide nasal bones is accomplished by surgically cutting/breaking the bones (called osteotomies) and repositioning them into a more favorable orientation.
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 bridge after removal of a dorsal hump.  When a hump is removed, it leaves a gap along the top of the bridge.  This gap needs to be closed so that there is not a depression on the top of the bridge. 
Narrowing a wide boney base (sides of nose): When the nose is wide where the nasal bones meet the cheek bones, osteotomies can be performed to narrow the width. This usually gives the bridge more definition from the front.

Straightening a deviated or crooked nose:  If the nasal bones are crooked, they can be repositioned to give the nose a straighter appearance.

Different surgeons perform osteotomies in different ways, but the basic premise is that a delicate instrument is used to surgically cut the bones under the skin. The surgeon then repositions them to acheive the desired result. Osteotomies usually increase the amount of bruising and swelling, but when performed correctly, can dramatically improve the appearance of the nose.

Kent V. Hasen, MD · Answer

For some reason, you appear to have wide nasal bones after your first rhinoplasty.  Either this was not fully appreciated at the time of the first surgery or somehow appeared after the first surgery due to healing/swelling.  The way to correct wide nasal bones and a wide dorsum of the nose is to perform a controlled fracture or breaking of the nasal bones at the junction of the nasal bones with the cheek bone, this is called a lateral osteotomy.  This is commonly performed in rhinoplasty to help close the "open roof" deformity that can be created with reduction of a dorsal hump to bring the paired nasal bones back .  Additionally, if a dorsum is very wide, an additional break is created at the top of the nasal bones to help narrow this portion of the nose, this is called a medial osteotomy.  You may require both the lateral and medial osteotomy, but you will only know by doing a complete consultation with a plastic surgeon who is comfortable with secondary or revision rhinoplasty.

Richard W. Fleming, MD (retired) · Answer

The 3/4 angle picture you submitted clearly shows the increased width of your bridge. This can be corrected by cutting the bones and repositioning them. A picture from the front will probably show that the bones do not join in the center of your nose. If there is any excess bone, this can be removed.

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