Is breaking the nose during rhinoplasty anything to worry about?

Most cosmetic rhinoplasty involves removal of a dorsal hump. This means the surgeon will cut, rasp, or remove the hump, leaving a flattened surface beneath the nasal skin. Unfortunately this widened flat surface (called an "open-roof" or book-spine deformity) often looks as bad as the previous bump or hump!The nasal bones that make up the sides of this open roof deformity can be brought together to restore the nasal pyramid shape by first "breaking" the bones so they can be narrowed. I suspect patients imagine the surgeon teeing off with a sort of club and whacking the nose to break it, or hitting the nose with a mallet!This does NOT happen.Instead, a tiny, sharp instrument with an edge guard called an osteotome is used to put a thin cut in the eggshell-thin nasal bones. The osteotome is tapped lightly with a  surgical mallet, and then the bones, once freed from their bases by the osteotomies, are gently clicked together in the middle, "closing" the open roof and restoring the nice pyramidal shape.This is not painful since you are asleep, and the bones are splinted to hold them in their new desired position post-op. Pain is not so bad at all (my own daughter used only Tylenol when I did her rhinoplasty with bone breaking at age 15! Look at my photo and you can see why she wanted "dad's nose" made smaller!) I suspect you will have as much pain with bones broken as you would if they were not. Also, no difference with open vs. closed as far as pain goes. You may have bruising from the bone edges, but then again, you may have bruising from rhinoplasty anyway without bony work.It's NOT "extra" pain, but trying to avoid breaking the nasal bones when this is a necessary part of the cosmetic improvements is a huge mistake that I occasionally see from other doctors. Don't let this happen to you by expressing fear of a usual part of the procedure (if done properly)! Best wishes! Dr. Tholen

Talk to your surgeon about this.  This is very common in rhinoplasty.Kenneth Hughes, MDLos Angeles, CA

One of the major components of rhinoplasty is performing osteotomies of the nasal bones. This is also known as breaking the nasal bones. It involves making small cuts in the nasal bone and resetting them in a more narrow position. Osteotomies are also performed when the nose is twisted and crooked. Osteotomies are necessary when a hump has been removed from the nose which leaves an open roof deformity if not closed with osteotomies.  In general, rhinoplasty is not a very painful procedure, and most patients take few pain pills the first night or 2 after the procedure. If the nose is packed at all with any gauze on the inside of the nasal passageways, that'll be much more painful than the osteotomies themselves. Look for a surgeon to does NOT pack your nose after the rhinoplasty procedure. Please see the link below to our rhinoplasty photo gallery where most of the patient's have had osteotomies performed.

"Breaking" the nose is a standard part of most, but not all, rhinoplasties. But we really don't break it like you may be imagining. the bones are very precisely cut by special instruments. This is done so the shape of the nose can be changed to a more satisfying look.