Two Conflicting Consultations for Rhinoplasty About Whether I Would Need Osteotomies, How Do I Decide?

One plastic surgeon (a facial plastic surgeon) told me that I would not need any osteotomies, just rasp the bump down. When I asked the doctor if this would be closed or open, they responded with, closed, but it would be great to do it open if I didn't mind the incision. I thought this answer was a little odd, also, they have only preformed about 20 rhinoplasties. Another plastic surgeon, told me that I would need osteotomies, and just filling the bump down is not recommended.

Doctor Answers 11

Based on your profile photo, you would likely require osteotomies during Rhinoplasty Surgery.

I read your concerns and reviewed your photo: You appear to have a large, long nose with an overprojected, underrotated tip and a profile hump. During surgery, after your hump is removed, you would likely require osteotomies to narrow your bridge on front-view. In my opinion, you might benefit from tip deprojection and rotation as well.

If you like, visit for a list of certified specialists near you.

Hope this helps.

Dr. Joseph

West Orange Facial Plastic Surgeon
4.9 out of 5 stars 418 reviews

Conflicting information from rhinoplasty consultations

Any time there is a large hump taken off of the nose, osteotomies must be performed to close the open roof deformity that results when the hump is removed.  This can be done quite easily through closed rhinoplasty, an open rhinoplasty is not necessary.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Two Conflicting Consultations for Rhinoplasty About Whether I Would Need Osteotomies, How Do I Decide?

I have performed Rhinoplasty for well over 20 years and from the photo, you have a large dorsal hump.  If this is to be removed, lateral osteotomies would be required to avoid the open roof deformity created by removing the dorsal hump.  This is the outcome whether the dorsal hump is rasped or removed with an osteotome.  This is a basic Rhinoplasty concept that I teach to Rhinoplasty Surgeons in training.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Rhinoplasty: Osteotomies or not

It is difficult to tell with one photo and without a physical examination, but it appears as though you would need osteotomies to reshape your nose once the hump has been removed.   Sometimes when removing a bony hump, the nasal dorsum is widened, and osteotomies are required to prevent an "open roof" as others have stated here.  Several techniques exist to achieve hump removal, and it is ultimately up to your surgeon to decide which technique will be used based on his or her experience.  You, however, get to choose your surgeon, and it is important that you express your concerns and have all of your questions answered during consultation with a board certified plastic surgeon.  Also, ask for before and after photos of patients with noses similar to yours.  All of these things will help you to make a well-informed decision. Good luck. 

Corey S. Maas, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 13 reviews

Conflicting Consultations for Rhinoplasty

It is not uncommon to get conflicting advice from surgeons with different experiences and preferences regarding techniques they use. With all due respect, your profile picture suggests that  osteotomies would be necessary after removal of the hump to avoid a broad, flat nose. Physical examination would clarify the need. All experienced surgeons do both open and close rhinoplasties depending on the needs of each patient. Four of us were the first surgeons in the United States to do open rhinoplasty, but I still use both techniques.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

A good rhinoplasty

To achieve a good natural looking nose that retains harmony with your other features an osteotomy and narrowing of open roof deformity is often indicated. Shaving a nose down may be a form of salesmanship that tries to minimize to the patient the nature of the surgery. You should be prepared to allow your experienced doctor to perform all necessary maneuvers to achieve the desired result . Performing a simple shave often leaves an unnatural "open roof" appearance. The tip and soft cartilages will need to be aligned and in harmony with the bony work. Go with surgeons who have rhinoplasty experience and above all go for the best results. Experienced surgeons should be able to show you numerous examples of their work.

Open or closed approaches are surgeons preferences and good results can be achieved with either approach.

Whether the result is good or suboptimal is more dependent on the choice of surgeon than on particular choice of incision.

Julian Henley, MD
Greeley Facial Plastic Surgeon

Do I need osteotomies?

Without a front view it's hard to say for sure, but my guess is you are looking to have a major reduction and will almost definitely need osteotomies. This is not something that should cause you concern. Getting the best result is most important, not the technique your surgeon uses.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Do I need osteotomies

It is hard to tell without an examination feeling the bones and without a front view photo. But I would think that you would need osteotomies due to the size of the bump on your nose. The need for osteotomies is based on the bones after removal of the hump. If you feel all 3 bones at that time you need to "close the open roof" or put the bones back together so the nose does not look wide. The bigger the hump, the more likely you will need it.

I would also recommend you do your research before picking someone to do your nose. You want experience as the first procedure is the best chance to do the right correction.

Rick Rosen, MD
Norwalk Plastic Surgeon
5.0 out of 5 stars 22 reviews


With a hump as large as yours seems to be ,you must close the open roof created by taking down the hump. If your surgeon does not do that you will have broad flat nose. Open vs closed depends on your surgeon and his experience. Really experienced surgeons use both techniques for different situatons. I do about 40% open the rest closed

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Conflicting consultations for rhinoplasty

It is very common for surgeons to disagree about procedures. Just look at responses on this site. What you need to do is find a surgeon with experience who can explain just what will be done, why, and how it will look. From a patient perspective (and the surgeon) osteotomy is not a big issue and if needed to close the bridge or narrow the nose, so be it. I think it will be needed, and can be demonstrated with computer simulation as without fracture, the bridge may become too flat. I also think the 'would be nice to do open' is odd as the surgeon should be prepared to do what is needed to get the results you expect, open, closed, the result is the real issue. Try another practice in your area.

Best of luck,

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.