Break or Not to Break Nose During Rhinoplasty?

What is the difference between having your nose broken or not during Rhinoplasty?

Doctor Answers 14

Rhinoplasty and Osteotomy

Most commonly the bones are shaved down over the dorsum and the hump is removed. Once this is done the base of the bones have to be broken to move the base of the bones inward to close the nose down into a pyramid.

I would not overly concern your self with the detailed parts of the surgery as if it is necessary it needs to be done.


Orange County Plastic Surgeon
5.0 out of 5 stars 72 reviews

Not always necessary to perform lateral osteotomy in rhinoplasty surgery

Not all rhinoplasty procedures require the breaking of the nasal bones, this is known as a lateral osteotomy. There are several reasons to perform this fracture. If a large nasal hump has been removed it is necessary to perform this controlled fracture in order to close the gap created when the hump was removed. The widest portion of the nose should typically be within a line drawn down from the corner of the eyes. This will narrow the nasal base and create nicer aesthetic lines.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 16 reviews

Breaking your nose during Rhinoplasty

As with everything else in rhinoplasty, all you need to do is describe the top three things you want improved in the appearance of your nose. Your ABPS Board Certified Plastic Surgeon will then help you decide if you need this done to achieve what you want out of the operation.

It makes a big difference if you do it or not for your recovery. I find this step in the operation to be one of the major determinants of how your recovery will be. Without breaking the bones, the recovery is a breeze. With breaking them, you may have a mild case of black eyes, a splint on your nose for up to a couple of weeks, a little more swelling and thus discomfort, etcetera. That being said, I find myself doing it very often -- because the patient's anatomy needs it to achieve the goal.

Some reasons to break the bones of the nose are if they are too wide at the base. If they're not too wide but there is a significant bump on the bridge of the nose that you're going to have reduced then we need to break them to bring them together once the bump is shaved off. Another reason could be if the nose is really crooked. There's a bunch of reasons, fortunately you don't need to worry about them. Your rhinoplasty doctor should be able to explain to you if you're going to need it or not...and sometimes he won't know until during the actual operation. I wouldn't suggest restricting your surgeon in this regard, he may need it to get you what you desire in your look for your new nose.

Ricardo A. Meade, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 109 reviews

Will my nose be broken during rhinoplasty?

"Breaking the nose" is a very crude term for something that is occasionally performed during rhinoplasty. The medical term for this is actually called an osteotomy. This is a very controlled cutting of the bone that is performed to narrow the upper portion of the nose.  It is not performed in every rhinoplasty. There are three situations when this usually comes up:
1) narrowing a wide nose
2) after a hump is removed the nose can sometimes be wide and this technique may need to be performed (see attached) and
3) Making a crooked nose straighter. 

Performing an osteotomy does not mean that your recovery will be any different then if it were not performed during your surgery.

Jacob D. Steiger, MD
Boca Raton Facial Plastic Surgeon
4.9 out of 5 stars 47 reviews

Nasal bones are reset when removing a large bump

The osteotomies or re-breaking of the nasal bone is performed to narrow a wide bridge. Once the large hump has been taken off the bridge the osteotomies and re-breaking of the nasal bones have to occur; otherwise, an open roof deformity will result, which will look like a flattop nose. If a small hump is present, these can be simply filed off and re-breaking of the nose will not need to occur.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

Options for rhinoplasty

Breaking the nose is usually done when a large hump is removed from the bridge of the nose or if the nose is too wide. Small humps can be gradually shaved down without the need to break the nose. Although, breaking the nose post-operatively is pretty well tolerated and it can give you a fantastic result. Good luck!

Deends on what is needed

Breaking the nose bones is called "osteotomy" and is done with more or less, a surgical mallet and chisel. The nose contains bone and cartilage components for the skeletal support. Only the bones are addressed this way. Osteotomy is used to narrow the bony part of the nose, and to straighten the bony pyramid. If these maneuvers aren't needed, no osteotomy is performed.

Rhinoplasty

Usually during a rhinoplasty, the bone is shaved down a bit, and this will flatten the dorsum of the nose. The bones are infractured to re-create the pyramid shape of the nasal bones and as a result the bones are a bit narrowed as well. If the dorsum is minimally shaved, then the dorsum is not flattened and infracture is not necessary.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Breaking nasal bones during rhinoplasty

The two main reasons that your nasal bones would need to be broken during a rhinoplasty are to either narrow the width of the nose or to reconstruct the dorsum after a large hump has been removed ("closing an open roof deformity" in technical terms). Therefore, there are some patients that do not need to have the bones broken as part of their individual procedure, but many do.

Many patients are quite concerned about this part of their rhinoplasty, and fear that it may be significantly uncomfortable, cause a longer recovery, etc. The reality is that there can certainly be more bruising and a bit more discomfort when breaking of the nose, or osteotomies, are required, but if it is necessary to achieve the desired result, both cosmetically and functionally, it needs to be done.

Hope that helps and good luck!

Dr. S

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 144 reviews

Break the nose during rhinoplasty

Osteotomies (breaking the nose) is the essential part for narrowing the bony part of the nose. When a nasal hump is reduced, oseteotomies are needed to narrow the nasal bridge.

If you are getting only the tip worked on, then osteotomies are not needed.

Regards

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 97 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.