My nasal bridge is wider after surgery. The doctor said my nasal bones moved outward during healing, is that possible? (Photo)

Question

I had a bridge reduction and shortening of a hanging columella. I am two years post-op. My nose bridge is much wider than it was before surgery and it looks like the bone was “scooped out” of the middle. I thought it was just wide from the swelling but then the swelling subsided and I realized it was the bone. My surgeon says he doesn’t break the bone so I don’t think osteotomies were performed, but he claims my nasal bones moved outward during healing – is that even possible?

Gerald Minniti, MD, FACS · Answer

Hello,Your osteotomies and/or bony manipulation was inadequate, possibly due to interference by intervening tissues (cartilage that lines the inside of the nasal bones), preventing sufficient medial transposition of bony element. This has left you with a wide flat surface of the bridge. You'll need a revision surgery, which should not be written off as a simple, in-office procedure under local anesthesia. Careful inspection of the tissues is mandatory so that proper maneuvers can be performed, which may include cartilage excision, transposition, or suture plication. Demand a revision rhinoplasty expert.

Steven M. Denenberg, MD · Answer

Usually, it's fairly predictable to move them closer to each other, but there may be complicating issues.
And they are sooo wide, really, it makes me wonder why the surgeon didn't narrow them at the time of your procedure, and splint them so they stayed narrow. You might want to re-evaluate him before having those bones narrowed. If he doesn't know how to do it expertly, it'd be better to consider other surgeons.
Also, you should evaluate your entire nose and see if there is anything else you want to have addressed, in the event you have surgery again.

Anthony Bared, MD, FACS · Answer

From the attached photos, it appears you have what is referred to as an open roof after your previous rhinoplasty.  It can be seen after a hump reduction.  To address your concerns osteotomies can be performed (fracturing to inset the bones) and the middle third of the nose would have to be re-supported.

Frederic H. Corbin, MD (license restricted) · Answer

Sorry for your problem and I would go on some complimentary consultations with experts who use digital photography to show you what can be accomplished with your nose and how it might be done to improve its overall appearance Dr Corbin

Michael Elam, MD (retired) · Answer

Dear Sburns84, Generally when the dorsum is addressed osteotomies need to be performed in order to bring the nasal bones back together or you can have what is called an "Open Roof Deformity." From the limited photograph it does appear that you have an open roof deformity that can be addressed with revision surgery. The scoop will also be addressed at the same time. Seek some consultations with experts in the field and have imaging performed to show you the proposed results and once the desired nose is agreed upon the surgeon can discuss the techniques that will be used to attain your desired result. Then review the surgeons before and after photographs to ensure expertise. For further information see the link and video attached. Best regards, Michael V. Elam, M.D.

My nasal bridge is wider after surgery. The doctor said my nasal bones moved outward during healing, is that possible? (Photo)

Answers (6)