Will my Doctor Break my Nose During a Rhinoplasty?

Many people are concerned that they will have their nasal bones fractured during rhinoplasty.  So, why would this need to be done in some cases and not in others? The simple answer is that when taking down a nasal hump, it is important to narrowing the nasal bones in order the close the "open roof" created during hump reduction.  Without this step the nose will appear too wide.  The other general reason is to straighten the nose when it is crooked. When tip work is the only thing that is needed, it is typically unnecessary to break the bones.  Recovery is prolonged a little as of a result and bruising is more common when the bones have to be broken. 

Nasal bones are "broken" in a delicate and precise fashion. We call this an osteotomy or cutting of the bone. It is needed if:

1) a hump is removed

2) The nose is crooked and needs to be straightened

or

3) If the nasal bones are wide and the patient desires for them to be narrowed,

Although this sounds scary - if your surgeon is experienced in rhinoplasty there is nothing to worry about!

Breaking the nose or performing an osteotomy is almost a routine part of nose surgery. It is rare that I do not have to perform osteotomies during the procedure. The reason that nose surgery requires osteotomies is to narrow and shape the nose. After the hump is removed or the tip is narrowed the bones need to be narrowed as well. Every part of the nose is interrelated and must be treated accordingly.

In my practice, I use an open technique called Piezo. The device I use for this technique works with special ultrasonic waves and vibrations and it only works on bone tissue and stops when it touches soft tissue. With the Piezo technique, I resize and reshape the nasal structure with no trauma to the surrounding soft tissues and the bone. Therefore, your nose will not be broken. With this technique pain, bruising, and swelling will be minimal and recovery time is faster. Hope this helps.

The bridge of your nose resembles an A-framed roof top which is narrow at the peak, and wide at the base. When a rhinoplasty surgeon removes a dorsal hump, your frontal appearance may widen, and this may be referred to as an "open roof deformity". Closure of the open roof, or narrowing the upper 2/3 of your nose after hump removal typically involves osteotomies. Infracture of nasal bones is performed in a controlled fashion and leads to the majority of bruising and swelling postoperatively. Osteotomies do not lead to a more painful postoperative experience, however. Hope this helps. Dr Joseph

Breaking bones is only necessary if you need to reshape a particular part of the nose, such as to narrow the bridge. It is not aways done as sometimes cartilage or soft tissue manipulation is sufficient to achieve specific aesthetic concerns. In addition, if your nose is broken, it is done very carefully and accurately, so that the break can be controlled. It's not like getting punched in the nose or something like that.

Rhinoplasty surgery varies from patient to patient and
depends on a variety of factors. Not every patient requires nasal infracture
(breaking the nose), but for some patients it’s absolutely essential and
without infracture it would be impossible to obtain a good result.

                  Patients
undergoing rhinoplasty require a comprehensive evaluation. This requires
physical examination and review of pictures from multiple angles. In your case,
it’s difficult to make a treatment recommendation without this information.

                  As
a general rule it’s usually necessary to perform an infracture when large humps
are present or when the nasal bridge is wide. When
isolated nasal tip abnormalities are present surgical infracture can usually be
avoided.

                  It’s
not unusual for patients to be afraid of having their nose broken during
surgery. Unfortunately for many patients meeting their aesthetic goals requires
infracture. When infracture is performed there may be slightly more swelling
and bruising. Patients usually have minimal pain and discomfort following this
maneuver.

                  If
you’re considering rhinoplasty, consultation with a board certified plastic
surgeon is appropriate. This surgeon should be able to help you formulate an
appropriate treatment plan.

The osteotomy (breaking of the bones) may not occur with your surgery.  This is used when a large hump has been taken down leaving a large flat surface. When an osteotomy is done it is done with very fine movements and delicate cuts to improve the shape of your nose.

Breaking the nasal bones, or controlled infracturing, during rhinoplasty is a delicate and refined technique to narrow the bridge of the nose.  If a large hump is taken down, the bridge may look like the top of an aircraft carrier.  The nasal bones then need to be brought in to round off the edges.  This creates a more refined and natural appearance.

Doctors do oftentimes during rhinoplasty break the nose in a very controlled fashion. While this takes a great deal of skill to do it appropriately and in a constructed manner you shouldn’t be fearful of having this done. Re-breaking the nose can allow the surgeon to straighten the nose as well as to make it smaller. In addition, with the controlled techniques that we use today, patients typically do not have a lot of discomfort after having rhinoplasty which includes breaking the nose or osteotomies. Discussing your concerns with your surgeon beforehand should make you comfortable with osteotomy if it is a necessary being a part of your rhinoplasty. 

It is considered an urban legend that whenever a patient has a rhinoplasty that the nose is “broken”. However, that is not necessarily true. It depends on whether this needs to be performed to improve nasal appearance or to correct nasal deviation. In my practice, about half of the time the nasal bones are not fractured or broken as part of a rhinoplasty. It depends on the analysis of the patient’s problem and what is needed to optimize the result for cosmetic improvement on the nose.