My main concern is the obvius wideness of my nasal dorsum in oblique view. The front view does not disturb me as much. My surgeon advised against osteotomy however, since he thought that it might make my nose look "weird", too flat or small. Instead he thought that he would only rasp the sides and corners of my nasal bones. Do you think that this would make enough of a difference? He also suggested raising my nostrils to make them more visible, and slightly thinning my tip. What would you do?
Could Shaving Be Enough to Slim my Wide Dorsum, or Do I Require Osteotomy? (photo)
Doctor Answers 5
Could Shaving Be Enough to Slim my Wide Dorsum, or Do I Require Osteotomy?
The photos show a C-shaped nasal deformity where the nasal bone and upper lateral cartilage is deviated to the right. There is a slight flatness, evident in one of the photos, that may represent a partial "open roof" deformity from the right nasal bone not meeting the left in the midline. If this is true, the right nasal bones should be fractured inward to close the open roof. This would also narrow the nose. If there isn't an open roof, the right nasal bone can be rasped to narrow the nose. Be sure your Rhinoplasty Surgeon understands and follows the proper aesthetics of facial (and nasal) beauty.
Osteotomies to slim wide nasal dorsum
Wide set nasal bones are reset to be more medial. Rasping the corners of the nasal bridge will take down small irregularities and humps, but will not do anything to narrow the nasal pyramid. The nasal bones are only 2-3 mm thick at that point and must be narrowed, not just filed. The tip can be thinned by removing a small amount of cartilage in the tip through closed rhinoplasty. Nostril show is usually not a good idea since it will make the nose look like it has been done.
Nasal surgery is performed to make the nose proportional to the face. In the absence of a localized problem like a hump, which you do not have, photos of only the nose (like you posted) are insufficient to plan or recommend any surgery. From these small focused photos alone I am not sure I would recommend any nasal surgery at all.
I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.
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Shaving the Nasal Bones
Shaving may be adequate to smooth the flat contour of the lateral nasal bones seen primarily in the oblique view. Pre-op I ask patients to define their goal; do they want me to rasp the nasal bones as much as I can without doing osteotomies or will they accept osteotomies if necessary. Tip refinement would be beneficial. Tip rotation would depend on how tall you are.