Many times patients come into my office seeking nasal surgery and they are fearful that I will have to break their nasal bones. They think this means I am going to have to break their nose and in their mind they envision me taking a big hammer and smashing the bones into several pieces. This cannot be further from the truth. In reality as you can see in this specimen the nasal bones only occupy the upper portion of the nose or the roof of the nose. It is quiet a distance from the bottom of the nostrils and it is an area that is only relevant to the upper part or bony vault of the nose as you can see between the eye sockets. In surgery where we are altering the bottom of the nose, we do not need to touch the nasal bones and they do not have to be repositioned at all. However, in some cases, i.e. a gentleman who suffered a ski injury causing fracture of the nasal bones. The nasal bones are now positioned so that the nose becomes crooked. In this case I had to use precise surgical instruments called osteotomes to make cuts in the bone and reposition the nose into a straighter alignment.
Others have an overdevelopment of the nasal bones creating a bump on the bridge of his nose. This type of deformity can happen from either trauma or just from a developmental abnormality. In this case, I would use an osteotome to lower the height of the nasal bones to create a straighter profile. Now not everyone wants a straight bridge. There are patients who want to preserve an outward curvature. There are some patients who want a little inward curvature, particularly some women. So we try to tailor our work on the bones to match the needs of the patient.
So overall the risks do not significantly increase just because we are working on the nasal bones. We are truly not smashing or breaking them. We are cutting them and repositioning them into a more favorable alignment. Working on the nasal bones is just one of many maneuvers we use during rhinoplasty to create favorable improvement for the patient in terms of appearance and functionality.