Is it possible to have rhinoplasty without osteotomy, and how will it fix my nose? (Photo)

Question

Im not looking for a major change in looks but just to correct the look of my nose as it really looks ugly from the right side. I was told that I could fix this problem without breaking major bones (no osteotomy) and thats by fix the tip of nose as its going downwards and rasp it little bit. I'm really against major nose surgeries even if it would make me look great. I really hate my look from the right side. The results I'm looking for are natural in a way nobody will notice a huge difference.

Ran Y. Rubinstein, MD · Answer

To answer your question I would like to address a few misconceptions.1.  Contrary to what most think, it is the tip work not the bony work (break nose) that has created the most "drastic changes" , complications such as nostril collapse, unnatural appearances.2.  The bridge of the nose is part bony and part cartilage.  When too much of the cartilage from the bridge is shaved down, you will get an inverted V-deformity.  Again, its the cartilage work that creates the most risk.3.  It is the bony work that heals the quickest, often within 6 to 12 weeks vs. the tip work, the swelling lasts up to one year.  I think patients become fearful when they hear that their nose has to be broken as they imagine these large bones being cracked.  In reality, the nasal bones are think and small and they are broken very delicately without much trauma when done properly. In your particular situation, you are probably unhappy with your profile when you look from the right side because both your nasal bridge (the bony part) and the tip are over projected.  To get a more pleasing and natural profile, both the bones and the tip would have to be treated.  These days, tip complications are minimized by not removing cartilage, from the tip or cartilagenous bridge, rather, reshape what you have to create more refinement.  Remember, It is the cartilage removal from the tip and bridge  that creates collapse down the road.  The nose can be broken very gently.Good luck,Ran Y. Rubinstein, MD
200 Stony Brook Court, Newburgh, New York
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Tanveer Janjua, MD · Answer

It is possible to do Tip Plasty that reduces the size of a nasal tip without making any major changes. This does not involve osteotomies but only cartilaginous work. It can be done under local anesthesia in the office. The nasal tip has cartilages only and no bone. The cartilages are partially removed and partially weakened. Everything is done from inside the nostrils and there is no incision on the nasal skin. The softening of the nasal cartilages in the tip makes the tip appear smaller in size. RegardsDr. J

William Portuese, MD · Answer

Every time a  moderate or large dorsal hump is removed, osteotomies are mandatory to close the open roof created from the hump removal.  It only takes 1-2 mm of rasping the bridge down to create a flat top nose and  Bridge line, so the osteotomies are required.   An open roof, flat top deformity also occurs when de- projecting the overly projecting nose. It is important to have a very balanced and natural appearing nose.

William B. Rosenblatt, MD · Answer

If you want your nose to look better, don't tie the hands of the expert. If you do, I can guarantee you will be unhappy with the result.

Steven Wallach, MD · Answer

If you require shaving down a dorsal hump, it depend upon how much it has to be taken down.  Osteotomies are necessary for flattened noses after rasping.

Andrew Kornstein, MD, FACS · Answer

The refinements you are looking for can be subtle but must be architecturally stable as well.You appear to have heavy skin; by reducing the underlying support indiscriminately you may be creating issues later in life. Structure is an critical component to any rhinoplastic plan for you.Hope this helps

Edward Farrior, MD · Answer

It is possible to perform a rhinoplasty without osteotomies, however in your case not a chance.  This is because your dorsum is so high and whenever you reduce the nasal dorsum a defect is created  that necessitates osteotomies to close what we refer to as an open roof deformity.  Based on your photographs you will need aggressive management of the nasal tip cartilages to shorten and refine the nasal tip as well as work on the nasal dorsum to reduce the overall size of your nose and improve the contour making your nose more complementary of your other facial features.  Every patient and surgeon should strive for a non-surgical appearance in their rhinoplasty.  This would include maintaining an adequate airway as well as a natural cosmetic result.  With rhinoplasty sometimes more can be less.  The ultimate goal is to eliminate a distraction and create a nose that is in harmony with the other facial features.

Dennis Barek, MD (retired) · Answer

Because your nose is large, wide and convex,  without an osteotomy, you would wind up with a much worse looking nose than you have now.I would refuse to take on a case like that where my hands are tied.

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