Hello Dr. Yang,
I have a slight bump on my nose from a break many years ago. I would like to have it fixed but not a full nose job but rather I have heard of a procedure where they don’t have break the nose but just file it down a little and is much less invasive than a regular nose job. Are you familiar with this and do you recommend this type of procedure? I really like your explanations and look forward to your response.
I don’t know whether or not I would recommend the procedure to you or not, since it may be enough of surgery for one patient, but not enough for another patient.
The typical reason a patient may get a minor procedure to file down the nose without performing the full rhinoplasty (nose job) is usually after the primary or first rhinoplasty is performed, and the patient is left with a small bump, bone, or cartilage which is protruding on the skin of bridge of the nose. This revision for this problem can potentially be performed using local anesthesia only in the office. For some patients, this may be okay to do it this way. But, for many, it may be a bit too stimulating and they would prefer to have IV sedation to have this done. A small incision is performed between the upper and lower nasal cartilages to provide access to the bridge of the nose. Then a small file/rasp is inserted in this small incision into the pocket between the skin on the bridge of the nose and the nasal bones and cartilages. The surgeon can then file down the bump or protrusion.
If the bump is too big, then it may not be enough to simply file down the bump. If the surgeon continues to file the bump and “sands off” the entire top layer of bone and cartilage, then this will leave something called an “open roof” on the bridge of the nose, which should be closed during the nose job (rhinoplasty) which requires breaking of the nasal bones called “lateral osteotomies” (osteo- meaning bone, and -otomy which means to cut.) If the bump is small enough for the surgeon to create a smooth profile on the bridge of the nose, without going through the entire top piece of bone and cartilage, then potentially it is a procedure which can be done.
The other limitation is if the patient feels their nose is too wide, then it is necessary to perform the lateral osteotomies to gently break the nasal bones to bring them together and narrow the overall width of the nose.
If you are fine with the shape, size, and positioning of the tip of your nose, the rhinoplasty is relatively easier smoothing the bump on the bridge of the nose +/- the lateral osteotomies, is still an easier procedure. If the surgeon creates pockets on the surface of the nasal bones for the micro-chisel prior to the lateral osteotomies, the amount of bruising (black-eyes) can be reduced significantly.
Although I think it is good to research the procedures and have some basic understanding of what is being performed, I think it becomes difficult for the surgeon to do their best work if the patient asks for only specific steps of a procedure to be done and doesn’t allow other steps to be performed.
Good luck with your rhinoplasty research and surgeon search.