How Does a Surgeon Decide if Your Nose Needs to Be Broken or Not for Rhinoplasty?

Whether nasal bones need to be broken, depends on the size of the dorsal hump being removed.  A very small hump can be just rasped and no breaking of the nasal bones is necessary.  If there is a large hump that is removed, it will result in a flat top or open roof deformity of the nose, which must be closed with osteotomies.  

This is a question that is not easily answered. First, it is important to understand that a rhinoplasty does not involve 'breaking' the bones; rather, there are precise cuts made in the bone so that the bones can be repositioned. If done correctly, it is a very precise and controlled process. Deciding who needs osteotomies is not always straightforward, but in general, if the upper (bony) portion of the nose is crooked, asymmetric, or requires narrowing, then osteotomies are often useful.