I had a rhinoplasty 18 month ago and my nasal bone is bumped out again. Is rasping enough? (Photo)

Question

I had a rhinoplasty 18 month ago and my nasal bone is bumped out again. My profile has a wave like shape. Is rasping of the nasal bone enough? Is it a big deal ? Is there a risk id be worse off? How long would the swelling take ?

Andrew Miller, MD · Answer

Your nose shows some excess bone growth which is pretty common at that location. It is at the bony-cartilaginous junction, and while rasping will bring down the bulk of the bump, some of it at the bottom may be cartilage which would have to be shaved slightly. Then the bridge will have to be judged to see if it looks too flat. If so, the nasal bones will be brought in some to create a nice smooth bridge. Be sure to see an experienced rhinoplasty surgeon to discuss your options.

Alejandro Nogueira, MD · Answer

I am sorry to issue such critical opinion, based on your photos for me it is very clear the problem:-you had dorsum removal with NO bone fracture (infracture of nasal bones)-in-fracture of nasal bones is a MUST when the dorsum is removed, otherwise the patient suffers a very very very well-known post-rhinoplasty deformity (google it): OPEN ROOF-probably if you focus a powerful light source through your nostrils you'll see the light illumitating the dorsal skin of the nose-absolutely under NO circumstances you should admit that the side edges of your nosal dorsum (now so prominent and unsighty) would be rasped-additional to the infracture of the nasal pyramid in order to close the dorsal gap, much likely you need paramedial resecion of dorsumYou need a very very good revisional surgeon of rhinoplasties.Regards

R. Laurence Berkowitz, MD · Answer

Remember the nasal bones are a hollow tunnel not a solid structure; rasping the sides of that hump may develop a more serious defect.  I am of the opinion that it is probably best to move the two bones inward by osteotomy. In addition the next level down, or the cartilaginous vault may be too narrow and require widening.  This will require a careful re-examination by your surgeon and perhaps more than one opinion before proceeding.

Michael R. Lee, MD, FACS · Answer

Correction of your dorsum can be accomplished through simply rasping down the edges of your nasal bones.  The skin of the nasal dorsum is very thin which makes this deformity so noticeable.

Vincent P. Marin, MD, FACS · Answer

From the photo, it does appear that your nasal bones are more prominent than ideal. Fortunately, this can be corrected by rasping or filing down the edges of the bones through a "closed" approach - no external incisions. This is less recovery than a full procedure, but still swelling would persist for weeks. You should see a board certified rhinoplasty surgeon in your area to get a formal opinion through and in-person consultation. Best of luck.

John Zavell, MD, FACS · Answer

From your pictures, it appears that you would have some improvement in your nose from the rasping.  However,  rasping alone would probably leave you with a wide flat upper part of your nose.  You would benefit from having the nasal bones tilted inward to narrow this part of your nose  in addition to the rasping.

Robert S. Schmidt, MD · Answer

Hi there. You have what's called rhinion horns. They are caused by the intersection of your nasal bones with the bony portion of your septum. The bony part of your nasal dorsum becomes shaped like a trapezoid instead of a nice dome. Generally, rasping can be pretty effective, however you may need osteotomies as well to bring the nasal bones in. This can be accomplished through a closed approach using an incision within your nostril. It's not a big deal revision, however you may have some increased swelling compared to last time because of scarring from your first procedure. It all depends on how much was done and how it was done.Good luck!

I had a rhinoplasty 18 month ago and my nasal bone is bumped out again. Is rasping enough? (Photo)

Answers (7)

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