Possible open roof deformity? Can you just shave down the sides where the bones stick out?

Question

I had rhinoplasty 3 months ago and am scheduled to have fine tuning surgey in 3 months time. My nasal bones don't seem to meet in the middle and the edges are sharp and stick out horribly. I am worried i have an open roof because the top is very flat and the bones do not meet/stick out sharply to the side. Can the look be improved by just shaving the bones that jolt out? Or will that make the middle valuve collapse? (I've heard taking too much bone away can do that). I feel very depressed.

Emmanuel Mallol Cotes, MD · Answer

Thank you very much for enquire.It's too early to make value judgments with 3 months after a rhinoplasty.Swelling after a rhinoplasty depends of the surgery complexity.In this regard, the nasal swelling Post-op It can last from two weeks to two months.To reduce this swelling, I recommend you perform delicates daily lymphatic drainage massage therapy over the face (around the nose) avoid sun exposure, and take pain/inflamation pills, as your surgeron precribe you.Kind regards, Dr. Emmanuel Mallol Cotes.-

Sean R. Weiss, MD, FACS · Answer

It sounds like you may have an open roof..  This is when the nasal bones have not healed to the midline.  The way to correct this is either with grafting or osteotomies or both.  Best Regards

Umang Mehta, MD · Answer

Thanks for the interesting question and photos. Closure of the open roof requires lateral osteotomies, small controlled fractures in the sides of the nasal bones, to bring them together. The bones can then be smoothed out with a rasp (file). At the same time, you may need spreader graft placement, to prevent your upper lateral cartilages from falling in further. It seems you already have some narrowing of your middle vault (the mid portion of your bridge), what we call an inverted-V deformity. A full exam would better confirm this, but the photos you posted are suggestive of this issue. This collapse can actually make the nasal bump/open roof look worse than it actually is. Importantly, correction of this internal valve collapse can also improve your breathing. An open approach is generally best for this type of surgery. The thin spreader grafts are ideally created from cartilage in your septum. In revision cases, ear or rib cartilage may be necessary, if the septal cartilage was removed during your first surgery. Be sure to consult with a few experienced revision rhinoplasty specialists, as the correction of your bridge should be relatively straightforward for someone experienced in this type of surgery. Best regards,Dr. Mehta

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. If you have an open roof deformity, then the best way to fix this is with osteotomies in a revisional surgery.  I recommend that you return to see your surgeon, as he/she will have a good idea of what to expect in regards to your specific progress, since they can evaluate you in relation to your preoperative appearance.Best wishes and good luck.Richard G. Reish, M.D.Harvard-trained Plastic Surgeon

Marcelo Ghersi, MD · Answer

Assuming you have an open roof deformity, an by your description, this may very well be what's happening, you will need osteotomies on your nasal bones. This will allow the surgeon to move the nasal bones to the midline, so there is no longer an open roof.

Possible open roof deformity? Can you just shave down the sides where the bones stick out?

Answers (8)