Can a Wide Dorsal Part Be Slimmed Down by Shaving It Down Without Breaking the Bone?

Question

I'm African-American and thinking of getting rhinoplasty. I have a slightly wide bridge and a slight hump on my nose, which I hate. I want to slim the bridge part of my nose without tip work, but i also dont want to have my nose broken to slim it. Is it possible to just shave down the bridge part of my nose without breaking the bone (osteomy), and still make it look natural? And if the bone is broken, will it ever heal enough to become as strong as it was before the surgery?

Thomas A. Lamperti, MD · Answer

Yes, a bump on the bridge can be shaved down without doing bone breaking. This would probably give the effect of widening your bridge, if anything, though. Concurrent controlled bone fractures to narrow the bones can help with narrowing the appearance of the nose from the frontal view.

	Performing these osteotomies doesn't usually change much in the way of recovery. There's a greater chance of having bruising after surgery as a result, though the pain and swelling are much different. The bones are set after about 6 weeks and you aren't any more likely to fracture your nose as you were before surgery.

Steven Goldman, MD · Answer

In general, breaking the nose seems dramatic but is not a big deal. It does usually cause mild to moderate bruising, but for a nose with a wide bridge, there is no other way to narrow the upper part of the nose. For many African American rhinoplasty patients, cartilage grafts to the tip and bridge will raise the height of the nose, making it appear less flat and more refined.

	Alternatively, some patients are candidates for non-surgical rhinoplasty to augment the tip and bridge with injectable filler. Make sure you find a surgeon familiar with rhinoplasty in general and African American rhinoplasty specifically. I hope this helps.

Theda C. Kontis, MD · Answer

I can't tell you how common it is to hear from patients who are contemplating rhinoplasty surgery that say they "don't want their nasal bones broken."  I'm  not sure why patients worry so much about this, because they are asleep during the procedure and the healing time is 1 week whether or not the bones are broken. I guess it just sounds violent.

	So, having said that, small dorsal humps can be shaved down without performing osteotomies. Larger humps or wide noses require osteotomies to narrow the bridge or improve a flattened dorsum after the hump has been removed (close an open roof deformity). African American noses can very from having no bridge at all, to having large bones and a hump, so you would need to be examined to see what surgical procedure you require..

	My advice to you is to see a rhinoplasty surgeon and get their advice about what improvements can be made on your nose, but don't limit their tools by telling them "no osteotomies."

David Shafer, MD, FACS · Answer

Rhinoplasty is a complex procedure and is not a simple as "shaving off" the unwanted areas.  Attention must be paid to the underlying anatomy and the support and structure of the nose.  In minor cases, the dorsum can be lowered by shaving alone.  However, you need to be careful since that can actually make the nose appear wider if the osteotomy is not also performed.  Additionally, if much bone is shaved, then you may be left with an open roof deformity if the osteotomy is not performed.  If you are seeing a board certified and qualified surgeon, then you really need to trust their opinion on what needs to be done during surgery to achieve your goals.  If you try to dictate what portions of the procedure can and cannot be done, then you may not get the result that you are looking for.  

	Good Luck.

Eric M. Joseph, MD · Answer

I read your concern. If you have your profile-bump filed down, the appearance of your nose on your frontal view may widen. To reduce this, osteotomies following hump removal is typically performed.

	I hope this is helpful for you.

	Regards from NJ.

Raja Mohan, MD · Answer

African American rhinoplasty is a cosmetic surgery procedure that reshapes the nose to improve its appearance and function while preserving the patient's ethnic features. It's also known as an ethnic rhinoplasty, a term used by many plastic surgeons to describe nose surgeries for non-European patients. The goal of African American rhinoplasty is to achieve a natural-looking result that complements the patient's other facial features. It can address a variety of concerns, such as:A wide nasal bridgeFlared nostrilsA deviated septumThe size, shape, or function of the nose The type of technique used depends on the patient's goals and specific characteristics. Some common techniques include:Alarplasty: Narrows the nostrils by removing soft tissueDorsum surgery: Narrows the cartilage and bone that runs down the nasal bridgeTip rhinoplasty: Reshapes, refines, or lifts the nasal tip Patients who are good candidates for African American rhinoplasty are usually in good health, non-smokers, and have realistic expectations.

Jon F. Harrell, DO, FACS · Answer

There is a small group of patients who can get a modest reduction in the bump located on the bridge of their nose without necessarily fracturing the nose. For most patients however, this maneuver widens the bridge of the nose and fracturing of the nose allows the bridge to be narrowed in an aesthetic fashion. Rasping has limited ability to narrow the bridge in my opinion. Nasal strength will return close to preoperative levels relatively quickly after surgery. An experienced nasal surgeon will be able to present you with your best options. Best of Luck Dr Harrell

Jeffrey Epstein, MD, FACS · Answer

Sometimes, but if a lot of the widened dorsum is to be removed, usually
	osteotomies will be indicated.

William Portuese, MD · Answer

It is impossible to narrow the nasal bridge without breaking nasal bones. A very small hump can be removed from the bridge without breaking the nasal bones. Removing a moderate to large hump will require osteotomies to prevent the square top or open roofed nasal deformity. Although the bones do heal and are fairly strong after the rhinoplasty, they do heal by fibrous union and are not quite as strong as they were prior to the rhinoplasty. This only matters if you get hit quite hard from a sporting injury.

Kenneth R. Francis, MD, FACS · Answer

Dear Poetry,

	A small dorsal hump can indeed be shaved down without having to break the nasal bones.  Narrowing the dorsal width by shaving without osteotomies is less likely.  Shaving down the dorsum generally widens the bridge of the nose even further.  I would recommend consultation with a plastic or facial plastic surgeon for a more complete evaluation and discussion of your options.  Good luck!

Can a Wide Dorsal Part Be Slimmed Down by Shaving It Down Without Breaking the Bone?

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