Closed Reduction with ENT and then Rhinoplasty later? Or leave broken nose as is and have procedures done together?

Question

My nose is broken and the ENT wants to do a closed reduction next week. Before the break I was considering having rhinoplasty done so it makes sense to have everything done at once. So my question is do I hold off on the closed reduction with the ENT and just let my nose heal crooked and then have everything (functional & cosmetic) fixed with a plastic surgeon? Or still do the closed reduction now and cosmetic Rhinoplasty later? How long will I have to wait before it's ok to have surgery?

Steven M. Denenberg, MD · Answer

I don't like the idea of making fine, definitive cosmetic-rhinoplasty changes right after a nasal fracture. The nose is swollen, the tissues have lots of dilated blood vessels, and you can't do the fine work to get the nose right where you want it.
So in general, I tell my patients to wait about 6-8 weeks and then have the fracture corrected and the real rhinoplasty done at the same time.
You don't *have* to do anything at all to a fractured nose. There is nothing magical that the surgeon does to "fix" a fractured nose. Lots of people have nasal fractures that are never treated.
The only point of having an operation soon after a fracture is to straighten the nose if it looks horribly crooked on the face. Then, it's fine, or even important. If the nose is just swollen, or just a small amount crooked and you're anticipating a real rhinoplasty later, then doing surgery soon can just complicate the rhinoplasty for no benefit.
So when I do an operation within a week of a fracture, I definitely don't try to make any cosmetic changes, and I try very hard not to make any incisions at all. All I do is get the person asleep, and push the bones back into the middle. And I'm done. Really, it's just what the high school wrestling coach does: the kid stands up from a hard fall, his nose is broken and very crooked, the coach puts his thumb on the kid's nose and pushes it back to the middle. Anything else complicates later surgery for (probably) no good reason.
I usually make computer morphs when I'm answering a RealSelf question, to show the changes that are possible for your nose with a rhinoplasty. For example see this page:FacialSurgery.com/RealSelf/RealSelf_Morphs.html
But of course you didn't submit photos for an opinion about the rhinoplasty. See the "Web reference" link, just below my post. At the *very* bottom of the Web reference page is a link to instructions on taking photos that are comprehensive and useful for online consultations like this, in case you'd like a more complete evaluation.

Jeffrey Marvel, MD · Answer

It is best to perform closed reduction now and wait several months.  Once the broken nasal bones heal out of place, it can be more difficult to correct with a rhinoplasty later.  Therefore, it is important to realign things now.  Usually you have about 2 weeks to perform the closed reduction.  After 2 weeks it becomes more difficult.

William Portuese, MD · Answer

In our experience for over 25 years, closed reduction does not give good results. We perform an open reduction with placement osteotomies in the nasal bones to reduce a nasal fracture that's been displaced. All of this can be performed through a closed rhinoplasty approach with all of the incisions placed on the inside of the nose. It's best only have one nasal surgery, not two, and find the right surgeon who can address both functional, broken and cosmetic issues with your nose. Look for a very experienced, double board certified  ENT/facial plastic surgeon for best results

J. David Kriet, MD, FACS · Answer

Thanks for your question! A closed reduction can help align the nasal axis but will not change the shape of the tip or profile. Aligning the deviated bones now may help facilitate your rhinoplasty in the future. Most surgeons prefer not to perform primary rhinoplasty in the setting of an acute injury as the healing can be more unpredictable. I typically delay definitive rhinoplasty for 6-12 months after nasal injury.
Best wishes!

Paul Loewenstein (retired) · Answer

I would go ahead and have a closed reduction now, and wait several months to do the rhinoplasty. If the bones are displaced and you do nothing now, it may be more difficult to correct this as part of the rhinoplasty.  Doing the rhinoplasty now would be a mistake in my opinion, for the reasons already stated in other responses.

Talmage J. Raine, MD, FACS (retired) · Answer

Does your nose look broken?k A quick closed reduction is very easy to do usually. If you are prepared to have, and pay for, your rhinoplasty now it is OK to go ahead.All the best,Talmage Raine MD

John M. Weeter, MD (retired) · Answer

Closed reduction of a nasal fracture and correction of any associated septal deviation can be done wither by an experienced plastic surgeon or otolqryngologit (ENT) who does nasal surgeries frequently. Generally a closed reduction should be done within about 10-14 days. Depending on the number of fragments of the nasal bones would affect trying to do an rhinoseptoplasty in the period shortly after the broken nose. It is also important to evaluate how crooked your nose it, whether the crookedness affect your nasal airway, and also whether the external deformity is now causing a problem with the wearing of glasses, if you do. Most surgeons would wait 6 months or more before doing additional surgery after a reduction of a nasal fracture or revision of a previous rhinoplasty, or rhinoseptoplasty.  
You need to ask yourself, can you live with the current condition of your nasal deformity, both shape and function, for 6 months. You may want to get a second option from an experienced surgeon or either specialty.   The real answer to your question will require an in-person consultation with your surgeon, including evaluation of diagnostic imaging, either  nasal bone X-rays or nasal & sinus CT studies.
I hope that this helps you and your surgeon make the best decision. Good luck.

Richard W. Fleming, MD (retired) · Answer

Have just one operation, a septorhinoplasty, to improve the appearance and correct the deviation secondary to the trauma, whether that be done now or at a later date.

Closed Reduction with ENT and then Rhinoplasty later? Or leave broken nose as is and have procedures done together?

Answers (8)

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