Narrowing nasal bone width: when does regret tend to occur?

Regret from bone-narrowing osteotomy tends to arise when the osteotomy is incomplete and when both sides of the bone are cut equally without assessing their individual conditions. The former can cause the shape to revert, and the latter is reported to lead to postoperative step-offs or asymmetry. We clarify the key distinctions to understand beforehand.

A leading cause of regret: insufficient bone cutting

By textbook standards, incomplete osteotomy is the most frequent complication in bone-narrowing surgery. It prevents sufficient bone movement, causing the narrowed shape to revert—a phenomenon called recurrence of deviation—or results in inadequate narrowing overall.[1].

For those with thin or small nasal bones, over-resection requires caution

In cases where the nasal bone is small and thin, repeating the osteotomy multiple times is reported to raise the risk of bone fragmentation or collapse. In such cases, adding contour (camouflage) before bone resection should be considered first.[2].

For the same reason, adding an osteotomy at a midline position carries risk of bone fragmentation leading to instability or worsening deformity, and is therefore not commonly performed.[3].

Cutting equally when asymmetry exists leaves a step-off

When the nasal bone is inherently asymmetric or tilted, removing the same amount from both sides may fail to move it fully to midline, leaving a step-off or bony asymmetry. Reducing the resection from the shorter side improves accuracy of midline positioning.[4].

Step-off deformity and bony asymmetry after osteotomy are positioned as findings that must always be confirmed when considering revision surgery.[5].

Short nasal bone types tend to become unstable after osteotomy

Preoperative assessment should evaluate not only the nasal bridge prominence or depression and axis tilt, but also the length of the nasal bone. Short bone types tend to become unstable after osteotomy.[6].

There can also be regret that manifests as difficulty breathing.

Beyond appearance, inaccurate bone-cutting technique can lead to bone deviation or collapse, which may result in nasal obstruction.[7]The indication for width narrowing itself is organized into closure of the roof, narrowing of wide bone, widening of narrow bone, and correction of irregularities or deviation—a technique that involves both appearance and function.[8].

What is understood about the sensation of "regret" itself.

In a general review of cosmetic surgical procedures, surgery chosen based on aesthetic expectations is considered a field where postoperative regret tends to occur due to the strength of psychological motivation.[9]However, please understand this not as data specific to bone-cutting width narrowing, but as a trend across aesthetic surgery as a whole.

There is also a systematic review regarding satisfaction questionnaires (ROE), but it does not present satisfaction data specific to bone-cutting width narrowing.[10].

Points to confirm during consultation.

The first is determining whether your nasal bone falls into the category of thin, short, or asymmetrical between left and right.[2][6][4]The second is whether an intermediate osteotomy is necessary.[3]The third is how to monitor for step-offs or effects on breathing after bone-cutting.[5][7]Since bone thickness and shape vary from person to person, which of the distinctions listed here applies can only be determined through an actual consultation.