When shaving or rasping the nasal bump down on the nose, where does the bone go?

Hi there,Good question, thank you.Rasping the nasal bones is an interesting technique with many pitfalls. There are a couple of parts to your question.Firstly, most of the rasped bone does attach to the rasp.  Living bone is slightly soft and sticky, unlike the dried bone you would see on a skull or skeleton for example.  But there are bone fragments left in the nose, and unless they are carefully flushed out with sterile saline irrigation they can cause problems. Usually after a rhinoplasty, the bone just heals as it is left by the surgeon.  But bone fragments are very osteogenic - that is they encourage new bone to form. So if bone fragments are left in the nose they can encourage a new bump to form. I've seen this. It can even cause osteitis, which encourages new bone to form in unwelcome spots. In the longer run, any dust like fragments of bone left in the nose would most likely be resorbed by the body. Larger fragments or splinters not taken out can remain, as a feelable and visible bump. In summary, carefully removing fragments and irrigating the nose to flush the dust out is very important.The second part of the question is smoothing the nose with a rasp.  I rarely use a rasp actually.  I prefer a very sharp osteotome, which is like a little chisel.  The reason for this is that when rasping the nose, we are usually rasping the bone - cartilage junction, not just the bone.  The rasp seems to prefer bone.  So it is easy for the inexperienced to over rasp the nasal bones, while leaving more cartilage than intended as the rasp might just run over it rather than rasp it down. I fine a sharp osteotome is much more accurate and controlled than a rasp.Having said that, many surgeons prefer a rasp and there is nothing wrong with that. Skilled control of a sharp rasp is important to achieve a smooth dorsum and accurate removal of the hump, and that can be done with a rasp if that is the surgeons preference.Hope this is of interest.Howard Webster.

The dorsal hump is composed of both bone and cartilage. To remove the cartilage, it must be cut with a knife or scissors. The bone is usually cut with an osteotome and entire hump removed  together as one piece. Once the hump is removed, minor adjustments are made with a rasp to file down  any minor residual irregularities. The small " sawdust" is removed with the filing  because  the rasp is grooved to pull the fragments outward. A final irrigation and cleaning of the bridge line and underneath the skin is performed to remove any residual material.  For  many examples of dorsal hump removal in our practice, please see the link and video below

This is a very astute question. The bone fragments tend to stick to the rasp itself and are removed. The wound is also suctioned and any visible or palpable fragments are taken out. An irregularity on the bridge of the nose resulting from a left behind bone fragment is very uncommon. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon