Introduction

Nasal bone osteotomy is a significant procedure in rhinoplasty, often used to adjust the nasal root height and improve the overall appearance of the nose. In New York City, where the demand for cosmetic procedures is high, understanding the top surgeons and the associated price list for nasal bone osteotomy is crucial for individuals considering this surgery. This article will provide an in - depth look at the procedure, the top - ten aspects, and the price - related information.

What is Nasal Bone Osteotomy?

Osteotomy refers to any surgical procedure in which a bone is cut in order to realign or reshape it. In the context of rhinoplasty, nasal osteotomies are foundational techniques. When patients considering rhinoplasty ask, “Will my bones be broken during rhinoplasty surgery?”, it's a misinterpretation of osteotomies that can increase anxiety. In fact, osteotomies are a complex but important surgical maneuver that, when done correctly, contributes to beautiful aesthetic results.

Traditional rhinoplasty often uses a hammer and chisel to create osteotomies. However, some advanced surgeons in New York City, like Dr. David Cangello, use piezo ultrasonic technology for all rhinoplasty osteotomies. Piezosurgery utilizes ultrasonic waves that allow the surgeon to create osteotomies with a tool called a piezotome. This technique affords a superior level of precision and avoids the physical trauma that can be caused by a hammer and chisel. Studies show that piezo rhinoplasty results in less bleeding and fewer complications during surgery and less swelling and a quicker recovery after surgery.

Types of Nasal Osteotomies

Lateral Osteotomies

A lateral osteotomy is indicated to close an open dorsum (open roof) and to narrow or straighten the nasal pyramid. It is commonly used when there is a need to bring the sides of the nose closer together after a dorsal hump reduction. For example, if a patient has a wide nose after the removal of a hump, lateral osteotomies can help restore the natural triangular shape of the nose.

Medial Osteotomies

A medial osteotomy is typically indicated when the entire nasal sidewall needs to be mobilized to help prevent uncontrolled or irregular back - fracture from the upper portion of a lateral osteotomy or to widen an overly narrowed bony nasal vault. This type of osteotomy is often used in more complex nasal reshaping procedures where precise control of the nasal bone structure is required.

Intermediate Osteotomies

An intermediate osteotomy is indicated when narrowing an extremely wide nose that has good height (bilateral osteotomy) is required, for the correction of a deviated nose with one sidewall that is much longer than the other, or when straightening a convex nasal bone is required. It is a more specialized type of osteotomy that addresses specific nasal deformities.

The Role of Osteotomies in Preservation Rhinoplasty

Preservation rhinoplasty is an advanced approach to nasal surgery that is designed to preserve the dorsum, including the thin layers of lymphatic and blood - rich tissue above (the periosteum and the perichondrium). Dr. David Cangello is a pioneer of this technique and one of very few surgeons in the United States who is experienced in preservation rhinoplasty. He is also one of the first few surgeons in the U.S. to have performed preservation rhinoplasty.

In a traditional nasal bridge procedure in which the goal is to remove or minimize a hump, the surgeon will typically remove a piece of the nasal bone, leaving the septum exposed, and then rely on grafts to shape the dorsum. In a preservation rhinoplasty procedure, Dr. Cangello employs very precise osteotomies in order to reshape the dorsum while preserving the native structure for a more natural - looking result.

In a preservation rhinoplasty procedure, Dr. Cangello will make a nasofrontal osteotomy across the radix, which serves to unite the preceding transverse osteotomies along the sides of the nasal bone where it meets the maxilla. Making these three osteotomies in continuity — lateral osteotomy on each of the left and right sides, both of which meet with the lateral aspects of the transverse osteotomy at the radix — allows the entire bony pyramid to move as one flexible joint, as opposed to separate pieces, which is how the bones move when traditional osteotomies are made. The osteotomies in preservation rhinoplasty allow the entire bony segment of the nose to be “preserved” as it is pushed downward toward the face after the osteotomies are made. This is in contrast with the structural approach to rhinoplasty in which the bones of the nose are rasped along the dorsum in order to reduce their height. Since the bones are thin, rasping them along the dorsum ends up separating the right from the left nasal bone, such that when lateral osteotomies are made, the bony pyramid is no longer a pyramid. It is separated into two (left and right) pieces of nasal bone. When the pyramid of the bony dorsum is pushed down in a preservation rhinoplasty, a straighter, more symmetrical nasal bridge is revealed without any need for reconstruction.

Top Ten Surgeons for Nasal Bone Osteotomy in New York City

While it's challenging to provide an exact top - ten list without in - depth research on every surgeon in New York City, here are some well - known and highly regarded surgeons in the field of rhinoplasty who are likely to be experts in nasal bone osteotomy:

1. Dr. David Cangello: As mentioned earlier, he is a leading rhinoplasty surgeon in New York City and one of the first plastic surgeons to offer preservation rhinoplasty in the U.S. He has developed finely honed surgical skills, including a precise approach to nasal osteotomy with the use of piezo ultrasonic rhinoplasty and preservation techniques, that is customized for each individual patient for natural - looking results.
2. Dr. Maurice M. Khosh: A New York facial plastic surgeon, he has extensive experience in rhinoplasty procedures. He understands when osteotomies are necessary, especially when dealing with large humps, and performs them with precision.
3. Dr. Ashkan Ghavami: Based in Beverly Hills but highly regarded in the industry, and may also have patients from New York City seeking his expertise. He emphasizes proper pre - operative analysis to determine whether an osteotomy is needed.
4. Dr. Corey S. Maas: A San Francisco facial plastic surgeon, but his knowledge and skills in rhinoplasty osteotomy are well - known. His expertise includes understanding when osteotomies are required to achieve the desired results during a rhinoplasty, especially in avoiding open roof deformities.
5. Dr. David A. Ross: From Chicago, he has experience in performing rhinoplasty with osteotomies. He can explain to patients that breaking the nasal bones during rhinoplasty osteotomy, though it sounds harsh, is often a necessary part of the operation and that patients usually require little pain medication post - operatively.
6. Dr. John M. Hilinski: A San Diego facial plastic surgeon whose knowledge of osteotomies in rhinoplasty is beneficial. He can reassure patients that experienced surgeons perform osteotomies with great precision, and swelling and bruising should be minimal.
7. Dr. Peter A. Aldea: From Memphis, he is experienced in performing osteotomies as part of a nose job (rhinoplasty). He describes osteotomies as controlled fractures that usually heal beautifully.
8. Dr. Carlos Wolf: A Miami facial plastic surgeon, he believes that nose surgery often requires osteotomies to narrow and shape the nose, and every part of the nose is interrelated and must be treated accordingly.
9. Dr. Ricardo A. Meade: Based in Dallas, he understands when osteotomies are necessary in rhinoplasty, especially when a patient wants a narrower upper third of the nose or after significant dorsum shaving.
10. Dr. Howard T. Bellin (retired): A Manhattan plastic surgeon who has a lot of experience in rhinoplasty and understands the gentle nature of osteotomies. He emphasizes that patients are usually under conscious sedation and do not remember the experience, and it does not contribute to additional post - operative pain.

Price List Information for Nasal Bone Osteotomy in New York City

The cost of nasal bone osteotomy in New York City can vary widely depending on several factors.

Factors Affecting the Price

• Surgeon's Experience: Highly experienced surgeons with a good reputation and a long - standing record of successful surgeries often charge more. Surgeons like Dr. David Cangello, who are pioneers in certain techniques like preservation rhinoplasty, may have a higher fee due to their expertise.
• Complexity of the Procedure: If the patient has a more complex nasal structure, such as a severely deviated nose or a very wide nasal bridge, the procedure will require more time and skill, resulting in a higher cost. For example, correcting a deviated nose with an intermediate short osteotomy, as described in some medical studies, is a more complex procedure compared to a simple dorsal hump reduction with basic osteotomies.
• Location of the Clinic: Clinics in prime locations in New York City may have higher overhead costs, which can be reflected in the price of the surgery. For instance, a clinic in Manhattan's upscale neighborhoods may charge more than a clinic in a less central area.
• Type of Anesthesia: General anesthesia is more expensive than local anesthesia. Most rhinoplasty procedures with osteotomies are performed under general anesthesia for the patient's comfort, but the cost of anesthesia will be added to the overall price.

While there is no exact price list for nasal bone osteotomy in New York City, a rough estimate can be provided. The cost can range from a few thousand dollars to upwards of $20,000 or more. However, this is a very broad range, and patients should consult with individual surgeons for accurate pricing.

Benefits of Nasal Bone Osteotomy

Improved Aesthetic Appearance

One of the primary benefits of nasal bone osteotomy is the improvement in the aesthetic appearance of the nose. It can correct a wide nasal bridge, a deviated nose, or a dorsal hump, resulting in a more balanced and attractive facial profile. For example, by narrowing the nasal bones after a hump reduction, the nose can look more in proportion with the rest of the face.

Enhanced Breathing

In some cases, nasal bone osteotomy can also improve breathing. If a deviated nasal septum or nasal bone structure is causing obstruction, correcting these through osteotomy can open up the nasal passages and improve airflow. This can lead to better sleep quality and overall well - being.

Boost in Self - Confidence

An improved nose appearance can have a significant impact on a person's self - confidence. Patients who are unhappy with the shape of their nose may feel more self - conscious in social situations. After a successful nasal bone osteotomy, they may feel more comfortable and confident in their appearance.

Risks and Complications

Bleeding

As with any surgical procedure, there is a risk of bleeding during and after nasal bone osteotomy. However, the use of modern techniques like piezo ultrasonic rhinoplasty can reduce the risk of excessive bleeding. In rare cases, patients may require additional treatment to stop the bleeding.

Infection

There is a small risk of infection after surgery. Patients are usually prescribed antibiotics to prevent infection, but if an infection does occur, it may require further medical treatment.

Scarring

Although most incisions in nasal bone osteotomy are made inside the nose, there is still a risk of scarring. However, with proper surgical techniques and post - operative care, scarring is usually minimal and not visible from the outside.

Unsatisfactory Results

There is a possibility that the patient may not be satisfied with the final results of the surgery. This could be due to various reasons, such as unmet expectations, minor irregularities in the nose shape, or a difference between the pre - operative plan and the actual outcome. In such cases, revision surgery may be considered, but it also comes with its own risks and costs.

Pre - operative Considerations

Medical Evaluation

Before undergoing nasal bone osteotomy, patients will need to have a thorough medical evaluation. This includes a physical examination, blood tests, and possibly imaging studies to assess the nasal bone structure and overall health. The surgeon will also ask about the patient's medical history, including any previous surgeries, allergies, and current medications.

Choosing the Right Surgeon

It is crucial to choose a qualified and experienced surgeon for nasal bone osteotomy. Patients should research the surgeon's credentials, experience in rhinoplasty and osteotomy procedures, and patient reviews. They can also ask for before - and - after photos of previous patients to get an idea of the surgeon's skills.

Discussing Expectations

Patients should have an open and honest discussion with their surgeon about their expectations for the surgery. The surgeon can provide realistic information about what can be achieved through nasal bone osteotomy and help the patient set appropriate goals.

Post - operative Care

Swelling and Bruising

Swelling and bruising around the eyes and nose are common after nasal bone osteotomy. The swelling usually peaks within the first few days after surgery and then gradually subsides. Icing the area and keeping the head elevated can help reduce swelling. Most patients look presentable after 8 - 10 days, but it may take several weeks for the swelling to completely resolve.

Pain Management

Pain after surgery is usually mild and can be managed with prescribed pain medications. Patients should follow the surgeon's instructions on taking the medications and report any severe or persistent pain.

Follow - up Appointments

Patients will need to attend follow - up appointments with their surgeon to monitor the healing process. The surgeon will remove any sutures, check the progress of the healing, and provide further instructions on post - operative care.

Activity Restrictions

Patients should avoid strenuous physical activity for a few weeks after surgery to allow the nose to heal properly. They should also avoid blowing their nose for a certain period of time as it can put pressure on the healing nasal bones.

Conclusion

Nasal bone osteotomy is a valuable procedure in rhinoplasty that can significantly improve the appearance and function of the nose. In New York City, there are many highly skilled surgeons who can perform this procedure with precision. However, it is important for patients to understand the procedure, the associated risks and benefits, and the factors that affect the price. By carefully choosing a qualified surgeon, having realistic expectations, and following proper pre - and post - operative care, patients can achieve satisfactory results from nasal bone osteotomy.

If you are considering nasal bone osteotomy to adjust your nasal root height in New York City, we encourage you to do further research, schedule consultations with multiple surgeons, and make an informed decision. Don't hesitate to ask questions and seek more information about the procedure and the surgeon's experience. Share this article with others who may be interested in learning about nasal bone osteotomy, and explore related topics such as other rhinoplasty techniques and the latest advancements in nasal surgery.