Can lateral osteotomies be reversed to widen the base and regain a hump?

Question

My face looks flat after lateral osteotomies were performed, I want to regain my side profile with nasal hump and a wider nasal base from the front. Is this reversible with piezo, even if previous osteotomies were performed without piezo? Do I need additional grafting?

Mark K. Markarian, MD, MSPH, FACS · Answer

Hello and thank you for your question.

First off, it's important to recognize that complications happen to ALL surgeons, and any surgeon that does not have complications or any suboptimal results is either not operating enough or is lying.

With that said, without an exam in person or any photographs, the surgery to augment your profile has multiple components.  My preferred way is a hybrid mastoid fascia and diced cartilage graft placed along your dorsum.  In my experience, harder/stiffer grafts can shift and displace.

Due to your prior rhinoplasty, the cartilage in your septum was likely harvested and so you will likely require MTF (Musculoskeletal Transplant Foundation) aka cadaver cartilage to perform this revision rhinoplasty.  Also note that if your septum is deviated and you have breathing difficulty, a revision septoplasty may benefit you as well, which can be covered by health insurance.

The next step for you is to pursue the right aesthetic plastic surgeon for your revision rhinoplasty.  In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, IN PERSON, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course.  I also think a key component of your consultation is to establish a good connection with your plastic surgeon.  This is difficulty to do without seeing your surgeon in the office, in person.  It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to my link below.

Good luck.

Andrew Miller, MD · Answer

Usually moving the nasal bones out will not add height to the side view. It is possible that too much nasal bridge was taken down, and you need a graft to build it back up again. Be sure to see a rhinoplasty specialist that can do computer imaging at the same time so you can figure out what you like best.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. A lot of this will depend on your specific anatomy. There are many different options that may help accomplish this. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Can lateral osteotomies be reversed to widen the base and regain a hump?

Answers (3)

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