Nasal Bone Narrowing for Rhinoplasty?

Question

My surgeon informed me that he will need to narrow my nasal bone in order to accomplish the desired look of my reconstructed nose. My understanding is the nasal bone must be broken. Is this true? What type of complications will surface with the nasal bone narrowing procedure? Is this a standard procedure in Rhinoplasty surgery?

C. Spencer Cochran, MD · Answer

Correction of wide nasal bones is accomplished by surgically cutting/breaking the bones (called osteotomies) and repositioning them into a more favorable orientation.
Osteotomies are performed during rhinoplasty for several reasons.

Narrowing a wide bridge (top of nose): One of the most common reasons for surgically breaking the nose is to narrow the bridge after removal of a dorsal hump.  When a hump is removed, it leaves a gap along the top of the bridge.  This gap needs to be closed so that there is not a depression on the top of the bridge (frequently called an open roof deformity.

Narrowing a wide boney base (sides of nose): When the nose is wide where the nasal bones meet the cheek bones, osteotomies can be performed to narrow the width. This usually gives the bridge more definition from the front.

Straightening a deviated or crooked nose:  If the nasal bones are crooked, they can be repositioned to give the nose a straighter appearance.

Different surgeons perform osteotomies in different ways, but the basic premise is that a delicate instrument is used to surgically cut the bones under the skin. The surgeon then repositions them to acheive the desired result.
Osteotomies usually increase the amount of bruising and swelling, but when performed correctly, can dramatically improve the appearance of the nose.
Risks of osteotomies (if not performed correctly) include irregularity of the bone, palpable or visible boney ridges underneath the skin, crookedness of the bridge, nasal sidewall collapse.

Jeffrey Horowitz, MD · Answer

Fracturing the nasal bones is a standard maneuver in rhinoplasty.  It is used to narrow the width of the nose and to close an "open roof", which can develop after a nasal "hump" is taken down.There are several complications that may result.  The most common sequellae are more pain and bruising than would result if it weren't performed.  Rarely, significant bleeding, airway compromise, damage to the tear duct aparatus, or palpable edge of the bone can result.A good rhinoplasty surgeon should warn you of all of the possible complications beforehand.Good Luck!

William Portuese, MD · Answer

Narrowing the nasal bones is a very standard procedure when performing a rhinoplasty.  Once the bony and cartilaginous hump has been removed, it is important to narrow the remaining nasal bones.  These are pre-broken by a technique used for osteotomies.  The reason that this is performed is to prevent a square top or flattop nose, which is also called an open roof deformity.  If the osteotomy is performed correctly, there is usually very little complication associated with them.  On a rare occasion, less than 5% of the time, they can heal crooked and have to be reset through a touch-up procedure.

Peter A. Aldea, MD · Answer

Dear Pickel,
Whenever a nasal hump is smoothed down or a nose needs to be narrowed the surgeon has to use a fine chisel and break the sides of the nose in a controlled fashion. The medical term for these fractures is osteotomies. The most commonly done osteotomies are the side ones - lateral osteotomies, but others may be needed to mold and create the nose you and your surgeon envision.
Nasal narrowing in SOME people may result in narrowing of the breathing space in the mid nose. This can be prevented by placing small cartilage grafts at the top of the septum called - spreader grafts. Rarely these days, if the nasal bones are totally separated from their lining (the periosteum) aggressive rasping and osteotomies can cause a mid nose collapse causing an inverted V deformity  (I repeat very rare).  The MOST common complication is swelling and bruising.
Yes - it is a common procedure. If you are seeing a qualified nose surgeon, I would not worry about it.
Hope this answered your question.

Richard W. Fleming, MD (retired) · Answer

Fracturing the nasal bones and narrowing the upper part of the nose is a frequent step in rhinoplasty surgery.While this may improve the appearance of your nose, it may also compromise nasal breathing. Various techniques can be used to minimize this effect.

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Nasal Bone Narrowing for Rhinoplasty?

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