How Do Doctors Decide When To Do a Rhinoplasty With Oesteotomy or No Oesteotomy? (photo)

I had my rhinoplasty done in Thailand to de-hump and improve the tip. My humps are still clearly visible especially at 45 degree views. My surgeon didn’t perform an oesteotomy. When I asked why? He explained after that because I’m biracial half asian-caucasian I did’t needed an oesteotomy because of the smaller and thinner humps than caucasians. Instead he overasped and now I have an inverted V-deformityWhen is an oesteotomy necessary and when is it not? How do I get rid of these side humps?

Doctor Answers 9

Your nose needs otseotomies

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Based on your photos it appears that you could benefit from a revision which would involve building tip support, minor hump refinement and osteotomies

Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Nasal Hump Removal with with No Osteotomy

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Regardless of ethnic background, removal of a hump without osteotomies can cause a flat bridge with an open roof deformity (your side humps). Nasal fractures (osteotomies) are usually necessary  but can be performed with a revision procedure. The inverted V deformity should be corrected with cartilage grafts at the same time. This will also improve nasal breathing.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

When is osteotomy needed?

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When a hump is removed and leave aside flat open space ("open roof") between the bones they need to be narrowed with an osteotomy.  You appear to have multiple issues occurring including deviation, middle vault collapse and residual hump. You will need more done then just osteotomy. Good luck!

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Hump removal

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When taking down a dorsal hump the bones dorsum looks flat and wide.  Osteotomies narrow the bones and improve the appearance of the flattened dorsum from rasping.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Why the osteotomy in rhinoplasty

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When the hump is removed the bridge will have a flat spot and sometimes an open roof where the edges of the nasal bone and the septum can become visible. The osteotomy helps close the bridge as well as narrow the bridge if needed. The inverted V you have can be corrrected by the osteotomy and a spreader graft to fill and hold the space in the bridge if you are unhappy with the result you have.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

How Do Doctors Decide When To Do a Rhinoplasty With Oesteotomy or No Oesteotomy?

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  This is a rather simple decision and is based upon the amount of dorsal hump (bone) that's removed.  In your particular case, the dorsal hump is greater than the 1.5 mm or so thickness of the dorsal bone.  When removed, an open roof deformity would occur requiring lateral osteotomies to close this along the upper edges of the nasal bones during Rhinoplasty.  Osteotomies can also be recommeded to straighten crooked or deflected nasal bones back to the midline on one or both sides.  

  Knowing when this is required is part of understanding and following the proper aesthetics of facial (and nasal) beauty for the creation of a naturally, more attractive nose and face.  Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Too bad you had incomplete incompetent surgery.

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You need to have the surgery re done by a qualified plastic surgeon who will do what is needed. Unfortunetly a lot of surgeons out of the country are really not qualified to do what they do. There is no simple answer to your question, but 30 years of experience in doing noses allows me to know when to do what is needed.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Osteotomy or not

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Usually with a significant hump reduction an osteotomy is necessary to close the open book deformity left with the reduction.  There are a few instances where the nose is already very narrow and the hump reduction is minimal where the osteotomies are not needed.  Also cases where no hump is reduced and only tip work is done may not require osteotomies.  Every case is different.  Donald R. Nunn MD  Atlanta Plastic Surgeon.

Donald Nunn, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 51 reviews

Nasal Hump

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It looks like you still need a hump reduction. Your hump was not fully reduced. If you reduce your hump you may need osteotomies to prevent an open roof deformity. Whether you have an osteotomy or not has nothing to do with your ethnicity. Osteotomies are performed to narrow the nasal bridge and avoid open roof deformities.



Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 285 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.