Rhinoplasty Osteotomy: Surgical Technique & Results

In rhinoplasty procedures, achieving a natural, balanced, and harmonious appearance with the face is always the primary goal. However, achieving this goal is not limited to interventions on the tip of the nose; in many cases, the bone structure must also be reshaped in a controlled manner. This is where osteotomy emerges as one of the most critical stages of the rhinoplasty process. If you’d like to learn more about this procedure, please check out our content. We wish you all good health and enjoyable reading.

What is the Osteotomy Rhinoplasty?

Osteotomy rhinoplasty is a surgical technique that involves the controlled cutting and repositioning of the nasal bones during cosmetic nose surgery. This procedure is performed specifically to correct issues such as a wide nasal bridge, bone deviation, trauma-related deformities, or an open roof deformity resulting from the removal of the nasal hump. Osteotomy performed as part of rhinoplasty allows the surgeon to reposition the nasal bones with millimeter precision, thereby achieving a nasal shape that is more harmonious with the face, symmetrical, and natural. In this context, the procedure is typically performed under general anesthesia and can be carried out using various techniques, such as lateral (side) or medial (midline) osteotomy. As a result, when properly planned, osteotomy rhinoplasty not only improves the aesthetic appearance but can also contribute to respiratory function by optimizing the internal nasal structures.

Types of Nasal Osteotomies and Their Indications

There are several main types of osteotomy rhinoplasty, depending on the surgical technique used. These types are as follows:

Lateral Osteotomy

Lateral osteotomy is a technique that involves making controlled incisions in the lateral walls of the nasal bones to move the bones inward. This is a commonly performed type of osteotomy. In this context, the procedure is generally used to narrow a wide nasal structure, correct the open roof deformity that occurs after the nasal hump is removed, and reshape the nasal bridge. It is also one of the most critical steps in the rhinoplasty process that determines the aesthetic outcome.

Medial Osteotomy

A medial osteotomy involves making incisions in areas close to the midline of the nasal bones. Due to its general nature, this procedure is not performed on its own but is combined with a lateral osteotomy. This allows for more controlled mobilization of the nasal segments and helps achieve a more stable and symmetrical structure on the nasal bridge.

Intermediate Osteotomy

As the name suggests, intermediate osteotomies are additional cuts performed between lateral and medial osteotomies. These cuts are typically preferred for more complex nasal deformities. They are performed, in particular, in cases of asymmetrical nasal structures or pronounced bone deviations to ensure that the bones are repositioned in a balanced manner. Additionally, this technique provides the surgeon with greater control and precision.

Internal (Closed) Osteotomy

Internal osteotomy is a technique in which all incisions are made entirely inside the nose. This technique leaves no visible scarring on the outside. It is frequently preferred because it offers a more minimally invasive approach. However, since the surgeon’s field of view is limited, it requires advanced experience and is generally performed in standard cases.

External Osteotomy

External osteotomy is a technique performed through very small incisions made through the nasal skin. This method provides the surgeon with a broader view and greater control over the bony structure. It is particularly preferred for revision rhinoplasty or cases involving complex anatomical structures. This is because any resulting scars are generally very minimal and fade over time.

Transverse Osteotomy

Transverse osteotomy, the most recent type of osteotomy rhinoplasty, involves incisions made in a horizontal plane on the upper portion of the nasal bones. This procedure is typically performed to correct excessive width or specific deformities in the upper segment of the nasal bones. As a result, it can be combined with other osteotomy techniques to achieve more comprehensive reshaping.

Why is an Osteotomy Rhinoplasty Performed?

This technique, used during rhinoplasty, allows the nasal bones to be cut and repositioned in a controlled manner. This makes it possible to narrow a wide bony structure, correct deviations, and create a more balanced contour along the bridge of the nose. It plays a critical role in closing structural voids that arise after a hump reduction, correcting asymmetries resulting from trauma, and repositioning a bony structure that appears disproportionate to the face. Furthermore, osteotomy does more than just improve aesthetic appearance; when performed with the correct technique, it can contribute to the regulation of air passages within the nose, thereby providing a healthier and more comfortable breathing process. In this regard, osteotomy is a strategic surgical step within the scope of rhinoplasty that establishes a balance between form and function.

When is Osteotomy Required During Rhinoplasty?

During rhinoplasty, osteotomy is performed in cases where reshaping of the nasal bone structure is necessary and is generally preferred only when intervention on the cartilage alone is insufficient. In this context, osteotomy is required in cases such as significant width of the nasal bridge, bone deviation, the need to correct trauma-related deformities, and the “open roof deformity” resulting from a nasal hump reduction. Additionally, this technique plays a critical role in balancing a bone structure that appears disproportionate, asymmetrical, or crooked relative to the face, and in achieving a more natural profile. Since achieving the desired aesthetic results can be challenging in procedures where the nasal bones are not sufficiently mobilized, osteotomy provides the surgeon with the ability to reposition the bone structure in a controlled manner. For this reason, osteotomy is a crucial surgical step planned within the scope of rhinoplasty in cases where it is deemed necessary for both aesthetic accuracy and structural integrity, directly influencing the quality of the outcome.

How Does the Osteotomy Rhinoplasty Process Proceed?

The osteotomy rhinoplasty process is a multi-stage procedure that begins with detailed preoperative planning and encompasses the surgical procedure and recovery period. During this process, the patient’s facial proportions, nasal bone structure, and aesthetic expectations are first analyzed to create a personalized surgical plan. Next, under general anesthesia, controlled cuts (osteotomies) are made in the nasal bones, and the bones are repositioned to achieve the desired shape. Thus, using lateral, medial, or combined osteotomy techniques as needed, the nasal bridge is narrowed, deviations are corrected, and symmetry is achieved. Following the surgery, swelling and bruising may be present in the first few days. While these symptoms gradually subside, the healing of the bones and the adaptation of the tissues can take several months. Consequently, regular follow-up visits with the doctor throughout the process are of great importance for both optimizing the aesthetic outcome and ensuring functional recovery within the scope of rhinoplasty.

Advantages of Osteotomy Rhinoplasty

Osteotomy rhinoplasty offers several key benefits. These benefits provide patients with both physical and psychological advantages. The benefits in question are as follows:

• Narrowing the Nasal Bridge: After the nasal hump is removed, the nasal bridge often appears wide and flat (“open roof” deformity). Through osteotomy, the lateral nasal bones are brought closer together, giving the nasal bridge a slimmer and more refined appearance.
• Correction of Crooked Noses (Asymmetry Correction): To correct congenital or trauma-induced deviations in the nasal bones, the bones must be released. Osteotomy allows for realignment of the bone structure, enabling midline alignment.
• Reshaping the Nasal Pyramid: In patients with a very wide nasal base, incisions made in the base bones adjust the angle and width of the nose relative to the face. This ensures the nose sits more harmoniously on the face.
• Improvement of Respiratory Function: In some cases, the position of the upper nasal bones can narrow the nasal passages (valve region). Correcting the angle of the bone structure through osteotomy can help alleviate structural blockages.
• Creating Natural Transitions: To ensure a natural appearance of the transition between the nasal bridge and the cheek after surgery, the bones must be moved in a controlled manner. This procedure reduces the “surgical” appearance of the nose, creating a more natural profile.
• Long-Lasting Results: While cartilage tissues may stretch or shift slightly over time, the healed bone structure (following osteotomy) maintains its position for a much longer period and in a stable manner.
• Low Trauma with Modern Techniques (Piezo): When osteotomy procedures are performed using methods such as ultrasonic (Piezo) surgery, only the bone is reshaped without damaging soft tissues, blood vessels, or nerves. This results in significantly less bruising and swelling post-surgery compared to traditional methods.

What is the Difference Between Traditional Rhinoplasty and Osteotomy Rhinoplasty?

In rhinoplasty procedures, the “traditional” and “osteotomy” approaches are generally not mutually exclusive but rather complementary techniques. However, certain differences can be observed in terms of their fundamental characteristics. These differences are as follows:

• Traditional approaches typically focus on the nasal tip cartilages (tip plasty) and minor cartilage irregularities on the nasal bridge. Osteotomy, on the other hand, is a surgical procedure performed directly on the nasal bones.
• While the nasal tip can be reshaped using traditional methods, the width of the nasal bones at the base or bridge cannot be altered. Osteotomy is the only method used to narrow the nose by breaking or cutting the wide nasal bones and bringing them closer together.
• In traditional methods, small humps can be corrected by filing (rasping). However, if the hump is very large, osteotomy is necessary to free and fuse the bones from the sides to close the “open roof” gap that forms on the nasal bridge after the hump is removed.
• If there is a significant deviation (curvature) in the nasal bone, traditional rasping procedures are insufficient. Osteotomy allows for a fundamental change in the bone’s position, realigning asymmetrical and crooked nasal structures to the midline.
• Traditional techniques use scalpels, scissors, and files. In osteotomy procedures, however, specialized osteotomy saws and hammers are used to cut the bone, or in modern surgery, ultrasonic Piezo devices that do not damage tissue.
• In traditional procedures involving only cartilage manipulation, bruising and swelling are minimal to nonexistent. Since bone is broken or cut during an osteotomy, there is a higher likelihood of bruising and swelling around the eyes (although Piezo technology reduces this risk, it does not eliminate it entirely).
• In procedures that do not involve altering the bone structure, recovery is faster, but structural changes are limited. Nasal bones reshaped through osteotomy provide a much more permanent and stable skeletal structure once healing is complete.

Is Rhinoplasty Possible Without Osteotomy?

Rhinoplasty is possible without an osteotomy; however, this depends entirely on the patient’s nasal anatomy and the extent of the correction to be performed. If the issue is limited solely to the nasal tip (cartilage structure), the desired aesthetic results can be achieved without altering the bony structure. In such cases, tip plasty, nasal tip reshaping, or minimal cartilage adjustments may be sufficient. However, if there are issues involving the bony structure—such as width of the nasal bridge, bony deviation, trauma-related deformities, or an open roof deformity resulting from a nasal hump reduction—achieving ideal results without osteotomy is generally not possible. This is because without mobilizing the bony structure, significant narrowing of the nasal form or achieving symmetry remains limited. Therefore, the necessity of osteotomy is determined by the surgeon following a detailed evaluation based on the patient’s facial proportions, bone-cartilage balance, and aesthetic goals.

If you wish to work with a team of experts in osteotomy rhinoplasty, you can contact the professional team at Faceaesthetics, specialists in rhinoplasty in Turkey.