Rasping Nasal Dorsum After Rhinoplasty?

Question

Since my Rhinoplasty a year ago, I have had 2 procedures to rasp the nasal dorsum.  The tip looks great, but the upper part of my nose still looks swollen on the top and on the sides. It almost looks like 2 separate segments. I did my research and know I have a top doctor, but am questioning whether it is typical to do this? What is the purpose of rasping the nasal dorsum? How long should I expect it to take until my nose looks straight and smooth?

Vincent N. Zubowicz, MD · Answer

The nose is composed of 3 aesthetic units: the upper bony vault, the middle cartilagenous vault, and the cartilagenous tip. A rasp is used to lower the bone of the upper aesthetic unit. It does not effect cartilage. The junction between the upper and middle units demands a symmetrical adjustment of the bone and cartilage components. The irregularity you describe might require some sharp pruning of the middle vault cartilage. I would suggest that you wait at least 6 months between any 2 operations. It often takes that long (or longer) for swelling to subside in the nose.

Sam Jejurikar, MD · Answer

Rasps are use to reduce the projection of the nasal dorsum and to smooth contour irregularities.  They are effective in treating the nasal bones, but cannot be used to reshape the nasal tip or other nasal cartilage.
Secondary procedures to fine tune the final appearance of the nose are sometimes needed.  Sometimes this consists of filler injections, steroid injections, or nasal taping, but in occasional cases, a secondary operation is required.  Nasal rasping can be done through an closed incision (incision within the nostrils) and generally is a quick procedure, particularly if no other steps of rhinoplasty are required.  Given that your upper nose has been treated 2 additional times since your original rhinoplasty, it's not surprising that is more swollen and wide.  
You should reach a relatively normal appearance 6 months after your last revision.  Until then, try to be patient!  Best of luck.

Richard W. Fleming, MD (retired) · Answer

The fullness you describe may be secondary to excess cartilage in the central part of the dorsum or excess bone in the upper 1/3rd of the nose. Rasping is usually used to correct a bony hump, although it is sometimes used to lower fullness in the cartilagenous dorsum. Therefore I'm not sure exactly where the problem is located. You also say the nose is "swollen" on the sides. It sounds like you need more than rasping. Although the nose  will not be totally healed in 3 months, by that time you should have a good feel for the final result.

Rasping Nasal Dorsum After Rhinoplasty?

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Rasping Nasal Dorsum After Rhinoplasty?

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