May 17

Rhinoplasty Mistake #1: The Scooped Out Bridge

In the last post we told you about how a rhinoplasty can go wrong. Now we’ll take you through each of the most common problems we see one step at a time and show what must be done to fix them.

A scooped out profile is probably one of the most common problems we see after rhinoplasty. It usually occurs after a typical reduction rhinoplasty when there was a bump on the bridge that was shaved down too much.

Below is a diagram of a nasal hump reduction.

Nasal Hump

This can happen for a few reasons. Many surgeons still prefer to make a bony bump smaller using a chisel or osteotome shown below on the left. We prefer nasal rasps, which are essentially fine files shown below on the right.

nasal osteotomes nasal rasps

Osteotomes are sharp instruments that cut through the bone at a desired level to lower the hump. This is an all-or-nothing thing where the bump is removed in one shot. The problem is one of judgment and execution. Sometimes the angle isn’t right or the surgeon thinks he or she is taking down the bone to a certain level only to find out that he or she misjudged.

It can be even easier to make this mistake using a closed rhinoplasty approach (from inside the nostril) where this maneuver is being done under the cover of the nasal skin. In this case, you can’t exactly see what you’re doing, so most of the work is done by ‘feel’. It takes a lot of experience to develop that ‘touch’ and to consistently get it right. We prefer to use rasps to reduce a bump. These instruments can be used to slowly whittle or file down the bony bump. That way we can accomplish this three-dimensionally in a very careful and controlled way.

When the bone is reduced too much, the nasal profile will look scooped and the bridge will look washed out and child-like from the front view. To fix this, we need to build the bony bridge back up again, most often with your own cartilage.

See the photos below to show the area of bone that was over-reduced, and what the bony profile should look like.

Poor rhinoplasty resultoverdone rhinoplastyrevised bridge

Now remember, we haven’t addressed any of the other problems with this nose yet. Check out our upcoming posts to see us make this nose beautiful again one step at a time.

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