Repeat osteotomy for a wide/splayed bone on one side only. Is it reasonable to believe a third attempt can correct it?

Prior to any surgery my nose was straight. Primary closed surgery which included spreader grafts caused right bone to heal very crooked. I had a revision a year ago also closed that included osteotomies and the bone is still set too wide and almost splayed looking. Gives the frontal view a very crooked & wide apperance. Is my case hopeless? Is it the technique of the doctor or maybe the fact that both surgeries have been closed? No tip work required, just would like straightER bones.

Doctor Answers 5

Third attempt at osteotomy

A third attempt will be successful only if the surgical plan is based on an accurate diagnosis.  For instance, if the right nasal bone is wide or splayed because the nose is shifted to the right (crooked nose), then osteotomies alone are not likely to solve the problem. However, if the nose is straight and structurally sound then you should be able to narrow the wide nasal bone with osteotomies alone.  Intermediate osteotomies can be helpful when the nasal bones are both wide and convex. In cases of extreme nasal bone width. it is sometimes necessary to remove a small segment of bone to make room for a successful osteotomy. 

Best of luck. 

Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 112 reviews

Crooked after multiple osteotomy

One cause of failure is the presence of a web of bone at the  open roof, near the radix. This prevents movement of the nasal bone medially, so it results in a crooked looking nose.
 The surgeon should look for this spicule of bone,and remove it. Perhaps an out fracture is needed first, the bone piece removed and then the nasal bones pressed together.

Dennis Barek, MD
Great Neck Plastic Surgeon
4.4 out of 5 stars 8 reviews

Osteotomy Procedure for Straightening Nose

Dear Lalaland310, Osteotomies can be performed with either a closed or open technique and this depends on the surgeon and what he/she is most comfortable with. A consultation and examination would be needed for a full diagnosis of what is causing your nose to appear crooked. If you only require osteotomies to straighten your nose then this is a very straight forward procedure when performed by an expert in rhinoplasty surgery. Best regards, Michael V. Elam, M.D.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 208 reviews

Revision rhinoplasty for osteotomies

 Osteotomies can be performed  with either closed or open techniques, depending upon the surgeon's preference. Since this is a tertiary rhinoplasty , the experience of the surgeon is very important, so that the one nasal bone  can be correctly placed back into alignment. Properly performed osteotomies  is one of the most difficult components to perform during the rhinoplasty procedure

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

It is possible but it's like a riddle


I believe that the main cause of lack of mobilisation of the bone is the residual tissues (scar, bone fragment, cartilage, spreader graft?) resting in the midline of the bony hump area, preventing the adequate approximation of the nasal bones.

The right approach probably would be to elevate the tissues (possible with closed technique) again, then remove what sits between the bones to create a free space for mobilisation of bones towards midline. 

In such a scenario it is doable. But there might be some other causes. At this point closer investigation should be mandatory.

Could guess more by the pictures though.

My best

Kamran Efendioglu, MD
Turkey Plastic Surgeon
5.0 out of 5 stars 8 reviews

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