To achieve a smaller nose, can this be a completed without breaking ? (photos)

Question

I want a smaller nose from side profile and also face on my nose up top has a wide bone . I want a smaller looking nose .please tell me if you agree my doc could achieve this without breaking my nose ? He told me he will not be breaking it. I go in 2 weeks and I want to hear your opinions ...if you were to do my nose would you just file it ?

Steven M. Denenberg, MD · Answer

... "breaking" the nose isn't a bad thing. Breaking the nose is where the surgeon makes a tiny incision in the nasal bones so they can be brought closer to each other. Many patients fear it, thinking perhaps that "breaking" the bone means that at a certain time, the patient will be awakened, and a big man with a sledge hammer will come into the room and swing at your nose. In reality it's a totally benign part of the procedure that shouldn't increase the bleeding or the swelling or the bruising, and you won't even know it's been done.Look at the Web reference link for a modification that I made of your nose, and also a link to a discussion of why the bones need to be narrowed if a hump is removed. If you look closely at the animation, you'll see that some of the bridge of your nose has been taken down. If that happens, and the bones are NOT brought closer together, then your nose will look unacceptably wide from the frontal view.Make sense?

Thomas A. Lamperti, MD · Answer

I'd ultimately need to see your nose in person, but it seems to me that your upper nasal bone width is wide currently. Controlled bone fractures can be used to narrow them in this case. Also, with smoothing down your bridge on profile view the result will be an even wider appearance unless the nasal bones are repositioned with osteotomies.You can learn more about wide bridge treatment at my web reference link below.

Sam Naficy, MD, FACS · Answer

To achieve the best result it would likely be necessary to perform osteotomies (breaking the walls inward) .  If that is not done, the nose may appear even wider after surgery, especially if the hump is removed.  Breaking the nose is not a big deal and is a very common part of rhinoplasty.   Out of the ~200 rhinoplasty procedures I perform every year more than half need osteotomies.

Ciro Adamo, PhD, MD · Answer

I would say that you are a candidate for a rhinoplasty with osteotomies. The bony part of your nose is quite wide, and the bridge fairly high. This can only be improved fracturing and repositioning the nasal bones. You can probably achieve a straight dorsum with a combination of very conservative bone reduction and tip remodelling/lifting, but this would not give the impression of a smaller nose. It is hard to tell looking at pictures only, but in your frontal view the chin looks a bit weak and asymmetric. There may be room for improvement there, too.

Kristina Tansavatdi, MD · Answer

What you are asking to achieve will require breaking the bones from the sides (lateral osteotomies) to prevent your bridge from looking wider after the hump is taken down. If this is not done you risk the possibility of having a wider bridge but also breathing problems down the road.

Stephen Weber MD, FACS · Answer

Your nose will require osteotomies (cutting the nasal bones) both to straighten the bridge and also to put the nasal bones back together after reducing the bump and the height of your nasal bridge. In my opinion, there is no way around that fact as not performing osteotomies will leave you with a wide, flat nasal bridge that looks very peculiar. Osteotomies are very safe and routinely performed during rhinoplasty. They can either be performed with a first rhinoplasty or during a revision but they are required for a natural looking result. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

William Portuese, MD · Answer

The photographs demonstrate a dorsal hump which is composed of both bone and cartilage.  A closed rhinoplasty  approach can accomplish shaving down the dorsal hump, which will look great from the profile view only. Once the hump has been removed, an open roof," flat top deformity" will be created from the frontal view. Osteotomies of the nasal bones are absolutely required to narrow the bridge line and close the open roof created from the hump removal. Remember, the nose is a three-dimensional structure and it must look good from all angles. Rhinoplasty is one of the hardest procedures to perform in the entire field of cosmetic surgery, so choose your surgeon very wisely based on experience.  For many examples of dorsal hump removal with osteotomies placed in their nasal bones, please see the link and video below

Robert Singer, MD · Answer

Keep in mind that following
advice from a surgeon on this or any other website who proposes to tell you
exactly what to do based on two dimensional photos without examining you, physically
feeling your tissue, assessing your desired outcome, taking a full medical
history and discussing the pros and cons of the operative procedure would not
be in your best surgery. Natural appearing results need to be individualized
and what is appropriate for one patient is not necessarily the best for someone
else. I would suggest that you find a surgeon with extensive rhinoplasty
experience certified by the American Board of Plastic Surgery and one who is
ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS)
or a facial plastic surgeon (otolaryngologist) that you trust and are
comfortable with. You should discuss your concerns with that surgeon in person.
The extent and length of the procedure, cost, and the specific operative steps
to achieve an ideal cosmetic result vary from patient to patient and would
depend on the findings at your consultation examination.Robert Singer, M.D., FACSLa Jolla, California

Dennis Barek, MD (retired) · Answer

I will agree of the preceding experts, in that your nasal configuration requires a hump removal and that will lead to a wide bridge with an "open roof". This can only be treated by osteotomy. You can closed the open roof without osteotomy by using a septal cartilage graft but you will still be left with a very wide bridge. That would not be very pretty, would it?,

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many Rhinoplasty surgeries over the past 30 years.  Based upon the attached photos your nose has a significant dorsal hump and is wide.  The chin is also quite weak.  A weak chin can make the nose appear larger and the mid face "top-heavy".  Chin augmentation, with a chin implant, will add volume to the chin creating harmony and balance to the lower face.    Rhinoplasty can reduce the height and width, of the nose, but once the nasal bones have been reduced an "open roof deformity" will be created.  This happens when the dorsal hump is greater than a few mm's which is the thickness of the nasal bones creating the hump.  The open roof deformity is closed as part of a Rhinoplasty by breaking the nasal bones so they re-meet in the midline.  Hope this explains why your nasal bones would need to be broken during your Rhinoplasty.  I frequently perform Rhinoplasty and chin augmentation with a chin implant to balance out the profile.

To achieve a smaller nose, can this be a completed without breaking ? (photos)

Answers (11)

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