Who is a good candidate for nasal bone narrowing (osteotomy)? Suitability depends on bridge width and bone shape

Nasal bone narrowing is suitable for people whose nose bridge appears wide from the root to the middle due to the bone's inherent breadth. If the broadness stems from the nasal tip or alar flare, narrowing the bone may not resolve the issue effectively. People with small nasal bones or those already concerned about nasal airway function should consider this carefully.

What changes with nasal bone narrowing osteotomy?

The root of the nasal bone is cut and repositioned inward, narrowing the width of the bridge in the bony portion[1]. When the nasal bone is broad, bone is cut on both the left and right sides[1].

In a study of 106 Asian individuals, the width of the bony portion of the nose narrowed by an average of 8.51 mm, and nasal height did not change[2]. The lateral profile angle of the nose also changed from an average of 155 degrees to 135.25 degrees[2].

Who is it suitable for?

Textbooks list the primary goals of osteotomy as narrowing a broad nasal bone, closing the roof that opens after hump (bridge bump) reduction, and straightening a deviated nasal bone[3].

The broad nasal bones common in Asian populations often accompany an eagle-like hump, requiring consideration alongside hump management[4]. It is also used to refine the nasal bridge line from the brow to the nasal tip[3].

For whom is it unsuitable or requiring caution?

People with small nasal bones. When multiple cuts are made in the small nasal bones common in Asian populations, the bone risks fracturing into fine fragments and collapsing[4]. Textbooks therefore recommend first considering methods to make the bone less noticeable without cutting[4].

Even for people with a broad nasal base, careful bone repositioning is recommended to avoid over-narrowing[5]. Narrower is not necessarily better.

Can the nasal airway become narrower?

Yes. With external bone cutting, the bone and cartilage move inward, which narrows the nasal airway.[3]This effect becomes more pronounced in people with longer nasal bones.[3].

For this reason, cartilage grafting to maintain the airway (spreader graft) may be recommended.[3]It also aims to prevent a reversed V-shaped depression in the nasal bridge.[3]If you already have nasal congestion, it is important to mention this beforehand.

How much swelling, bruising, and bony irregularities should I expect?

External bone cutting is considered the main cause of swelling and bruising after nasal surgery.[6]A method using ultrasonic vibration to cut bone (piezo) showed less swelling, bruising, and pain than conventional instruments, according to a summary of 10 studies involving 554 people.[7].

Bony irregularities at the cut site can also occur. In a study comparing both sides in 30 people, irregularities were observed in 47% on the side cut from inside the nose and 36% on the side cut from the skin side.[8]Research results differ on which approach is better.[6].

Things to confirm before the procedure

There are three reference points for judgment. First, whether the thickness of the nasal bridge is due to bone, or due to the nasal tip or skin.[1]Second is the size and length of the nasal bones.[3][4]Third is your baseline nasal airway.[3].

The size and length of the nasal bones may not be apparent from appearance alone. During your consultation, confirm with your doctor whether your nose requires bone cutting or if reshaping without cutting is suitable for you.