Rhinoplasty Without Breaking Nasal Bones?

Question

I'm thinking about having a Rhinoplasty done to make the tip of my nose smaller, the end is fat and kind of wide. I'm just wondering, can the surgeon just remodel the tip without breaking my nose bones?

David C. Pearson, MD · Answer

I've noticed that many prospective patients on the web are particularly worried about the bones and having to "break" them. Fact is, the majority of the work, difficulty, and complications with rhinoplasty tend to be related to the soft-tissue work of the tip and mid-third. The bones are often the least difficult part of the surgery and are not "broken," but rather precisely cut and repositioned. Since the nasal bones are thin, just rasping a large hump, for example, without cutting bone can create what's known as an open-roof deformity.
That said, if there's nothing wrong with the shape and proportions of the bones, then there's no reason to touch them at all. We call this a tip rhinoplasty.
 
All the best,
--DCP

C. Spencer Cochran, MD · Answer

If the shape of the tip is the only modification, it is possible to perform a tip rhinoplasty or "tip-plasty" without having to surgically break the nasal bones.
"Tip rhinoplasty" can be performed via a closed rhinoplasty or an open rhinoplasty. In closed rhinoplasty, all the incision are placed on the inside of the nose. Open rhinoplasty involves connecting the intranasal incisions with an incision across the column of tissue between the nostrils. Closed rhinoplasty is certainly appropriate for some tip deformities, but many surgeons prefer the open approach to correct major deformities of the tip because the open approach allows direct visualization of the structures.

John Diaz, MD · Answer

Yes, it is possible to do a rhinoplasty without "breaking" the bones. However, it is often necessary to make sure the whole nose appears balanced.
For example, if the surgeon narrows the tip significantly, the bones may then appear too wide. The contour of the nose may then be "off," with the bones being wider than the tip. This would not look good. 
I have found it is actually rare for someone to have a wide tip but have narrow nasal bones. Thus, fixing the tip and narrowing the bones is often necessary.
To narrow the bones, they must be "broken." However, as one of the other doctors already pointed out, this is not merely a breaking action. This is a very precisely controlled cut along the bone that enables the surgeon to reposition it. In fact, most surgeons will agree that fixing the tip is far more complicated and tricky than fixing the bones.
In summary, it is possible to have a rhinoplasty without the need for "breaking" the bones. It is only done if it is necessary to ensure balance.

Toby Mayer, MD · Answer

We often do just the tip without touching the rest of the nose. See an experienced rhinoplasty surgeon who has good before and after photos of patients like you.

Otto Joseph Placik, MD · Answer

Yes, only the tip of the nose can be treated and we call this a tip rhinoplasty.
This can be performed using the open or closed technique.
You may require the use of grafts to refine or enhance the tip. Most likely this could be obtained from your septum if necessary.
Generally the recovery tends to  be faster but tip swelling can persist for up to 6 months.

William Portuese, MD · Answer

It is possible to perform a tip plasty on the nose without doing much along the lines of the bridge. If there is a large hump that needs to be removed, the nasal bones do need to be broken and then a cast placed across the nose afterwards. A limited tip plasty can be performed, but the rest of the nose must be in good balance relative to the new tip for that to occur.

Rhinoplasty Without Breaking Nasal Bones?

Answers (6)

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