Open roof: What's the best surgical method to correct it?

Question

I had a primary rhinoplasty 4 years ago to remove a hump. The profile looks nice now but the frontal is bad (wider than before). The doctor didn't do osteotomies. I can feel the edges of the 2 bones on my nose bridge and there is also a dent in between which feels a little ticklish if I touch it. If I do a revision rhinoplasty will the dent close completely? Would it still feel ticklish? Once osteotomies are performed and moved to the right place, will they stay in that place forever?

Thomas J. Walker, MD, FACS · Answer

Correction of an open roof deformity requires a revision rhinoplasty. Typically, osteotomies are performed to bring the nasal bones together and spreader grafts are placed to fill the gap and stabilize the nose. You should see a revision rhinoplasty expert to be examined in the office to develop an appropriate treatment plan.

Eric M. Joseph, MD · Answer

Feel free to re-ask your query with photos. If your hump was removed, and if your nasal appearance is wide on front view, you may wish to consult several reputable rhinoplasty specialists so you could see what might be best for you.Wishing you well.Dr. Joseph

Fred G. Fedok, MD, FACS · Answer

Anastasia_Blue: Without seeing you or pictures, it is hard to give you a firm confident answer that pertains directly to you.  In general, one "closes" an open roof by performing osteotomies and mobilizing the nasal bones toward each other.  At times some rasping is then required to smooth the bone edges.  At times the placement of a small amount of crushed cartilage may be necessary to be placed over the site.  In general these tasks can be performed without an external incision.I hope this helps and good luck!Fred G. fedok, MD FACS

Steven Wallach, MD · Answer

I think that in order to determine whether or not you need a rhinoplasty revision you should post photos or be seen in person.

Anthony Bared, MD, FACS · Answer

Although difficult to assess your deformity without photos an open roof can be addressed via a revision rhinoplasty.  In order to adequately address an open roof in a revision rhinoplasty, the bones would need to be reset with osteotomies and likely spreader grafts would have to be used to "fill" the void between the septum and bones.  Consult with revision rhinoplasty specialists to develop a thorough assessment and plan.

Jeffrey Marvel, MD · Answer

The open roof deformity can easily be corrected in most cases by peforming lateral osteotomies.  This closes the roof and narrows the nose as well.  Recovery would be 3-5 days.  Total cost would be about $5000.

Curtis Perry, MD · Answer

Typically osteotomies followed by pushing the two nasal bones towards the middle is the typical method to treat an "open roof". Sometimes an onlay bone or cartilage graft is done instead. Without a thorough exam or at the very least before and after pictures it's impossible to give any more specific advise.

Harry V. Wright, MD · Answer

An "open roof deformity" describes a defect of the nasal bones following surgery. An "inverted V deformity" is what it looks like when you drape the skin and soft tissue of the nose over those bones.Imagine a dollhouse with a high pitched roof, and then saw the upper 2-3 inches of the roof off. You would be able to look down into the attic through the defect. Similarly in rhinoplasty, if you remove a dorsal hump made of cartilage and/or bone (especially a large one) you can look down inside the nose through the resulting defect, i.e. the "open roof".If you then threw a blanket over the dollhouse, you would still be able to see the defect of the roof through it, right? You'd be able to tell that the normal architecture of the roofline was altered, and instead had been replaced by these two parallel ridges with a slight concavity between (representing the cut edges of the roofline and the empty space between them). This is analogous to the inverted V deformity -- it's what the open roof deformity (a defect of the nasal bones and cartilage) looks like when the nasal skin covers it, and the shadows it causes look like an upside-down V. To slim the nasal bridge and correct an inverted V would require making surgical cuts in the nasal bones that account for the width of the bridge, called osteotomies. Spreader grafts may also need to be placed to maintain the nasal airway. This is a fixable problem. I recommend seeking out consultation with a Board-certified Facial Plastic Surgeon or General Plastic Surgeon who is experienced in revision rhinoplasty.Best wishes!  Harry V. Wright MD

Francis R. Palmer, III, MD (retired) · Answer

Hi, from your description, this does indeed sound like an "open roof deformity".  The best way to close the open roof is to perform osteotomies and bring both nasal bones together in the midline.  Hope this helps.

Open roof: What's the best surgical method to correct it?

Answers (9)

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