Is outfracture during revision too risky?

Question

Is outfracture during a revision too risky? I have read mixed things on the good ol' internet and would prefer hearing opinions of professionals. If bones were over-narrowed and resulting in apparent collapse, how possible is it to reverse that? I am also wondering if it is a similar procedure as when someone's nose gets broken and needs outfracture. Is it any more difficult than that during revision? I know revision in general is tricky but just wondering about the bones, specifically.

Kenneth Hughes, MD · Answer

Outfracture does not pose a particular challenge. Once the bone is osteomized it can become a mobile segment that needs to stabilized. There are a few tricks for this, but I would anticipate a good outcome. Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties and rhinoplasty revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results. Kenneth Hughes, MD Los Angeles, CA

Steven Wallach, MD · Answer

Out fracturing the nasal bones can be done to widen their appearance. This may be combined with other maneuvers to give you the result your looking for.

William Portuese, MD · Answer

It is possible to widen narrow nasal bones by performing osteotomies and holding them open and wider with spreader grafts. Please see the link below for examples of patients we have widened their narrow nasal bones

Andrew Pichler, MD · Answer

Out-fracture in itself is not difficult. What YOU actually need is however up to the PS you consult with. The revision may involve more than just a simple out-fracture.

Sean Freeman, MD · Answer

Outfracturing the nasal pyramid in revision work is not as uncommon as you may think. I would estimate that around 10% of my revisions need the nasal bones lateralized somewhat. I do believe it is easier to infracture than outfracture; when you infracture the ventrum of the bony/cartilaginous septum offer a firm resting spot for the anterior part of the nasal bones. This isn't true for outfracturing but should you find an experienced surgeon who routinely performs revisions your chances are very good you'll have a pleasing outcome. Look for someone with over 10 years of experience, look at lots of photos and make sure they specialize in facial work/rhinoplasty. Good luck!

Richard W. Fleming, MD (retired) · Answer

The nasal bones can be repositioned during a revision rhinoplasty. In your case it sounds like the bridge is too narrow - what you describe is a reasonable, safe technique. Sometimes grafts are also necessary. An experienced revision specialist will discuss the surgical plan.

David Alessi, MD - Account Suspended · Answer

If the nasal bones are too thin, then outfracturing them in an experts hands is very doable.  Other alternatives include grafting.  The exact nature of what needs to be done will be determined by an in-person examination. 

	All the best

Is outfracture during revision too risky?

Answers (7)