I'm Getting Jaw Surgery to Correct an Underbite. How to Ask for a Nose Procedure to Be Performed at the Same Time?

July 29:moving top jaw forward. In Feb:fell on my nose, bled profusely, didn't swell much, no bruising under eyes so I didn't get checked.My bridge is wider and uneven.Looks like my lower nasal bone & top of upper lat cartilage are flattened diagonally to the right:2cm long,1 cm wide.The sides of my nose are uneven when I smile & I can't smell.What nose surgery do I need?Is it ok to ask if it can be done since they're in that area?Should I ask my surgeon or a plastic srgn?Is it too late to ask?

Doctor Answers 8

Major rhinoplasty not a good idea at same time as maxillary advancment

Based on your description, your nose sounds like it is twisted and has associated nasal septal deviations and nasal collapse. Repair of these issue would require major septorhinoplasty best performed by someone who specializes in rhinoplasty and revision rhinoplasty. If you are having Lefort advancement of your maxilla, then it would be best to wait several months after your jaw advancement to undergo a septorhinoplasty because the foundation of your nose will change after your jaw surgery and because of intraoperative and postoperative airway risks associated with performing nasal and jaw surgery concomitantly. In light of the precise millimeter changes necessary to ensure optimal results in your nose both aesthetically and functionally, then you owe it to yourself to have the best timing and best surgeon for your situation. An in-person evaluation by an experienced nasal specialist potentially before your jaw surgery can help with coordination of surgical plans and timeline between your jaw surgeon and nasal surgeon. I would be happy to provide you with an evaluation and discussion of the multiple considerations in planning complex nasal surgery after prior jaw surgery.

Baltimore Facial Plastic Surgeon
4.9 out of 5 stars 57 reviews

I'm Getting Jaw Surgery to Correct an Underbite. How to Ask for a Nose Procedure to Be Performed at the Same Time?

I do not think it is a good idea or possible to do both procedures at the same time since you are having maxillary advancement from your description. This will involve cutting of the bone that also need to be cut for rhinoplasty. Would do one and allow healing to complete before doing the other.

Mohsen Tavoussi, MD, DO
Orange County Facial Plastic Surgeon
4.6 out of 5 stars 12 reviews

Jaw and nose combiation surgery

I suggest that you defer the nose for two reasons.Moving the upper jaw foreward is a big procedure that might compromise your airway. Also, it might change what your surgeon would do for the nose itself.

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Jaw surgery and rhinoplasty together

 A rhinoplasty is possible with mandibular surgery but does present some problems.  The lower jaw surgery requires a nasal tube for the general anesthesia and would have to be changed to an oral tube after the lower jaw is finished.  The problem arises after surgery if for some reason you had to be wired shut due to inadequate rigid plate fixation; you could experience airway problems.  Nasal surgery at the same time of maxillary osteotomy has been done but the results are compromised due the changes the maxillary movement may have upon the nasal structures.  So the best outcome with the least complications would be to stage the jaw procedures with a secondary rhinoplasty after all edema has resolved and bones are healed.  Donald R. Nunn MD, DDS  Atlanta Plastic Surgeon

Donald Nunn, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 47 reviews

Moving Maxillary Bone and Rhinoplasty at Same time

Your nose is adjacent to the maxillary bones which will be repostioned to improve the dental occlusion. Therefore, you should delay the rhinoplasty until after the maxillary avancement, which may change nasal appearance and influence what is done during your rhinoplasty.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

LeFort I osteotomy and rhinoplasty surgery at the same time is not advised.

I agree with the other colleagues who have advised deferring rhinoplasty until after your maxillary advancement, and I concur with their reasons--these are not minimal concerns, even if your surgeon thinks it is OK (which I doubt he/she would).

But there is one other concern that has not been mentioned. While there are many  craniofacial experts in ABPS-certified plastic surgeons' ranks, as well as other specialties that include acknowledged experts in LeFort osteotomies, such as ENT (facial plastic surgeons) and oral and maxillofacial surgeons, your best option for rhinoplasty surgeon may not be the surgeon who is performing your maxillary advancement. If he or she IS also an expert in rhinoplasty, I would expect a similar recommendation to defer rhinoplasty surgery until your facial surgery has completely healed.

I'm not saying that your LeFort I surgeon is incapable of performing rhinoplasty, but perhaps there may be a better option for you. Sort of like asking your electrician to fix a plumbing issue--maybe there's a reason they specialize in one area.

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Rhinoplasty and LeFort I Osteotomy Not Best Done Together

While there are instances when a rhinoplasty can be performed in conjunction with orthognathic surgery, coordinating with upper jaw or a LeFort I osteotomy is not one of them in my opinion. There is too much manipulation of the upper jaw and the base of the nose to make a concomitant rhinoplasty procedure reliable in terms of getting the best result. There are also intraoperative issues of changing the endotracheal tube, that while not difficult, unnecessarily complicate the anesthetic. You would be far better to do your rhinoplasty at least 6 months after your maxillary advancement. A better and more predictable rhinoplasty result will be obtained that way.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Communicating with your plastic surgeon

 You should have an open, frank discussion with your plastic surgeon and discuss a possible Rhinoplasty, if that is your wish.  The surgeon will then evaluate your nose and give you his/her opinion on whether you are a suitable candidate or not.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.