When Osteotomies Are Used to Push the Nasal Bones Together Does This Lower the Dorsum Height?

Question

Hello, I had rhinoplasty to remove a small hump from the bridge of my nose. The surgeon did this without making osteotomies- the hump was just filed down. Unfortunately, I am unsatisfied with the result as my nose looks much wider and there are 2 uneven bumps on either side (I believe them to be the edges of the nasal bones. I am wondering whether if I have this revised, would the height of the bridge of my nose be lowered through making the osteotomies? I do not want it to be any lower. Thanks.

Colin Pero, MD, FACS · Answer

If you imagine looking down from a helicopter at two mountains with exactly the same base width, then the mountain that is taller will actually look thinner due to the shadows formed along the sides of the mountain. This may help explain why your nose looks wider after removing the hump. You may need the base of your nose narrowed (osteotomies) and/or a graft placed on top to raise the bridge slightly. Making the osteotomies itself will likely not lower the bridge any more. You should meet with your doctor to discuss.

Hannah Vargas, MD · Answer

Like many cosmetic surgeries, pictures are essential for a thorough evaluation.  That said, the problem with not doing osteotomies is that a flattening of the nose can result (open roof deformity).  Sometimes patients will actually ask pre-operatively not to have the osteotomies because they don't realize the importance of this step. 

	Yes, this can be fixed in a revision. I recommend waiting at least 6 months to let things settle down to get a better idea of your final result.   As well, there are tricks to heighten the bridge of your nose which can also be addressed at the next surgery.

	Try to explain to your surgeon what you like and don't like about your nose and let them come up with the surgical plan.

	Good luck! 

	Vargas Face and Skin

Michael L. Schwartz, MD · Answer

Lowering a bump of significant size without osteotomies turns a triangle into a trapezoid. You have what is called open roof and need to see your surgeon about an osteotomy. It will not change your height.

David A. Bray, Sr., MD · Answer

Not addressing the need for lateral osteotomies after hump removal is a cardinal sin. Doing these will close your open roof narrow the bridge but, i doubt that it will change dorsal height significantly

Francis R. Palmer, III, MD (retired) · Answer

When Osteotomies Are Used to Push the Nasal Bones Together Does This Lower the Dorsum Height?

	What you are describing is called an "open roof deformity" where the nose appear wider after hump removal and there is a space between each nasal bone as they no longer meet in the midline.  The inside of the nose is hollow and when removing a nasal hump that's bone, osteotomies to bring the nasal bones back together, in the midline, are usually...not always...required.  Photos, of your nose would allow for a more thoroug evaluation however, if an open roof deformity does exist, a Revision Rhinoplasty with osteotomies to close this would be required.

	Osteotomies tend to raise, not lower, the nasal dorsum as the bones move closer together they gain actual height.

When Osteotomies Are Used to Push the Nasal Bones Together Does This Lower the Dorsum Height?

Answers (6)