Should I rasp the nasal bones only or should I also have an osteotomy? (Photos)

Question

The surgeon who is likely going to do my surgery wants to rasp the bones and not do an osteotomy. He says my upper lateral cartilages are fine and not too large. Where would you “draw the line” between rasping only and doing osteotomies. Would you do osteotomies on my nose? Thank you.

Luis A. Mejia, MD · Answer

hello thank you for your question and provided information as well.. based in your question its difficult evaluate your i case dont with this angles, its recommended if you get a consultation in person with a plastic surgeon to discuss all about theme.

Thomas J. Walker, MD, FACS · Answer

Thank you for your question. It is best to leave the decision as to what technique is utilized up to the surgeon. What you and your surgeon need to focus on is your aesthetic goal. The technique utilized is secondary and at times is made in the operating room. With all that said, it appears you have some bony edges on each side of your nasal bones, which typically get rasped for a smoother appearance and smoother transition from your bony dorsum to the bony sidewalls. If the nasal bone subsequent to that appears widened, lateral osteotomies might be performed. Again, this is an intraoperative decision and judgment call by your surgeon. Best wishes!

Paul E. Goco, MD · Answer

Thanks for your question and photos.  Your surgeon uses his/hers assessment of your current nose and the relative harmony to the rest of your face to determine what would be best.  Digital morphing can provide some visual representation of the differences.  If you have concerns, seek a second opinion.  Best!!

Philip K. Robb Jr., MD, FACS · Answer

Thanks for your question!I think it's best to defer to your surgeon on this one. Ya'll have surely discussed your goals and if they think that your goals can be accomplished by rasping only, then there you have it! I don't believe the patients should try to dictate how their rhinoplasty is performed. That being said, it's extremely advantageous to be educated in process so great job in that! Hope this helps and God Bless!Dr. Robb Jr.

William Portuese, MD · Answer

First of all, It is it was important to find out what the patient's goals are regarding each individual nose. From the photographs presented, there's a bony and cartilaginous dorsal hump which can be shaved down. Osteotomies accomplish straightening and narrowing the entire bridge line which includes the nasal bones and the upper lateral cartilages. Only filing down the bone will make the cartilaginous dorsal hump appear larger. Best to discuss this with your operative surgeon. Osteotomies are performed in the high majority of  rhinoplasty procedures

Mehdi Sina, MD · Answer

Hi,In general, when a large hump is rasped, osteotomies are required. If the goal of the surgery is to smooth out the upper third of the nose to get rid of the sharp angles, rasping is sufficient. So I tend to agree with your surgeon that you are fine with just rasping. Best,

Barry L. Eppley, MD, DMD · Answer

The pertinent question to this decision is based on what aesthetic objectives do you want to accomplish. Do you just want the visible upper dorsal lines reduced or the entire nasal bone width less as well. This are different rhinoplasty maneuvers that accomplish different nasal reshaping effects.

Eric T. Waterman, MD, FACS · Answer

Thank you for posting photos. I suspect you would be fine with rasping as opposed to osteotomies because the bridge of your nose overall is quite straight. There are two small protrusions, one on each side of the bridge of your nose that could be rasped away during surgery. Achieving a symmetrical result is simpler with rasping than with osteotomies, and in your case it may be the preferable means of addressing your bony dorsum. Just keep in mind that you should only take a few millimeters off with rasping alone.

Jon A. Perlman, MD (retired) · Answer

I think it's rare that a patient gets a satisfying outcome from simply rasping the nasal bones alone. Most patients have wide nasal bases that respond best to lateral osteotomies and infracture and this appears to be the case in your picture. Of course this needs to be confirmed in a face-to-face physical examination but in all probability I think you would gain from nasal bone infractures as long as they are not done too aggressively. Best wishes,Jon A. Perlman, M.D., FACSDiplomate, American Board of Plastic SurgeryAssociate Clinical Professor of Plastic Surgery Geffen/UCLA Medical CenterExtreme Makeover, ABC TV plastic surgeonBeverly Hills, Ca.

Should I rasp the nasal bones only or should I also have an osteotomy? (Photos)

Answers (9)

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