Possible to Correct Bridge Alignment with Closed Rhinoplasty?

Question

I had a revision rhinoplasty 9 months ago and my results vary. The center bridge to between my eyes is crooked (alignment is off) but the middle to tip are straight! Can this be corrected via closed rhinoplasty because I do not want to go through all the swelling and recovery again? Or do I have to have open because its the upper bridge and you have to do things all over?

Kevin M. Robertson, MD, FACS · Answer

It's likely that you can stil address your concern through an endonasal approach.  The nose is divided basicly into thirds, with the upper third comprised of your nasal bones.  If the lower two third (septum, and tip) are straight, you most likely need to remobilized the bones.  Those osteotomies are part of most rhinoplasties, and should be effective in straightening your final result. 
Sometimes other steps are necessary, but without seeing you in person, most would expect osteotomies to be curative.  That is a simple, quick procedure, requires anesthesia (we require the IV access only), and would cause bruising that still takes roughly a week to heal.  Same external bandage, although it might be suggested to come off a bit earlier in order to have you and your doc manipulate it to help keep it straight.  Good luck.

Sam Naficy, MD, FACS · Answer

correcting a crooked bridge with closed rhinoplasty is possible but depends on the severity of the problem.  the open approach is better in more complex scenarios

Richard Greco, MD · Answer

I love Closed Rhinoplasties and I use it for almost 99% of all Rhinoplasties. The upper third of the nose is controlled by osteotomies and fracture of the boney base. I usually use a 3 mm ostetome from the internal approach and a 2 mm osteotome from an external approach. One has t make sure that you have a good fracture and not a greenstick that can end up back where it came from leading to a crooked appearing nose in the upper third.

Scott Trimas, MD · Answer

To answer your question if the tip of your nose is satisfactory as is the middle third of your nose, it may be entirely possible to do a closed approach and just do osteotomies to narrow and straighten the upper third of your nose. Typically, work on the upper third does not require an open approach unless you need grafting or additional work done to the rest of your nose. This is a general statement but I hope this information helps.

Behrooz Torkian, MD · Answer

It is difficult to answer this question without seeing you, but I would say that there is certainly a chance that your bone irregularities can be fixed without completely opening the nose again. Occasionally grafts may have been placed in this area that could have moved during healing. This would have to be known prior to attempting this correction. As always, it is best to see the surgeon who last operated on your nose and have a drank discussion about what can be done to optimize your revision rhinoplasty result.

Sigmund L. Sattenspiel, MD · Answer

There are many rhinoplasty surgeons who are very adept at performing “closed” (endonasal) rhinoplasty. Even difficult revision cases can usually be performed by endonasal approach in the hands of many surgeons. On the other hand, a number of rhinoplasty surgeons feel more comfortable performing virtually all of their procedures with the external approach. The comfort zone of the surgeon is most important in achieving optimum results. Nevertheless, in your case, the bridge of the nose can certainly be managed with a “closed” technique.

William Portuese, MD · Answer

Certainly a closed rhinoplasty can address all of the realignment problems of the nasal bridge bones, upper lateral cartilage, and lower lateral cartilages. There would be no reason to perform an open rhinoplasty to do any bridge work.

Steven Wallach, MD · Answer

Tough question. It really depends upon what you look like on physical exam.  Remember no nose is completely straight.  All have at least minor deflections to one side.

Richard W. Fleming, MD (retired) · Answer

You and your surgeon will decide which approach is best for you. Based on your description, a closed (endonasal) technique is appropriate to revise your nasal bridge.

Possible to Correct Bridge Alignment with Closed Rhinoplasty?

Answers (9)

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