Superior rhinoplasty outcomes with precise nasal osteotomy: an individualized approach for maintaining function and achieving aesthetic goals

Ghanaatpisheh M, Sajjadian A, Daniel RK.

What this paper says

Reviewing 150 consecutive rhinoplasties, the authors found the bony nasal vault was asymmetric in most patients and set out an individualised cutting plan, with 33 percent of the 97 patients followed for a year needing no base osteotomy at all.

Overview

Nasal osteotomy, the controlled cutting of the nasal bones to narrow or straighten the bridge, has been hard to predict. The authors argue this is because a standard sequence of cuts is applied to bones that vary in height, length and width between patients and between the two sides of one nose.

Sections of note

Clinical outcomes reviewed for 150 consecutive rhinoplasty patients.
97 cases with at least 12 months of follow-up were evaluated in detail.
A lateralised medial oblique osteotomy was performed in 92 of 97 patients (95 percent).
Bilateral intermediate osteotomy was required in 70 patients (72 percent) and unilateral in 21 (22 percent).
Bilateral base osteotomy in 41 patients (42 percent), unilateral in 24 (25 percent).
No base osteotomy in 32 patients (33 percent) whose lateral bony wall was already an acceptable width. Level of evidence 4.

What it means for a patient

Most noses are not symmetrical, so the bone cuts on the left and right side are often different.
A third of these patients needed no cut at the base of the nasal bones, which shows that narrowing is not automatically part of every rhinoplasty.
The stated aim is to protect breathing as well as appearance, since bone cuts can narrow the nasal airway.
This is a single-practice case review with no comparison group and no patient-reported scores, so the claim of superior outcomes is not measured against an alternative method.

Why this paper matters

Osteotomy is one of the least standardised steps in rhinoplasty and a frequent source of asymmetry after surgery. Documenting how often each type of cut was actually needed gives a concrete picture of variation between noses. What is unanswered is whether an individualised plan produces measurably better results than a routine sequence.

Terms

Osteotomy: a planned surgical cut through bone.
Bony vault: the upper third of the nose, formed by the paired nasal bones.
Medial oblique osteotomy: a cut running upward and outward near the midline of the bony vault.
Intermediate osteotomy: an extra cut in the side wall of the nose, used when it is very wide or curved.
Base osteotomy: a cut at the lower edge of the nasal bones, used to move the side wall inward.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Although frequently performed in rhinoplasty, nasal osteotomies have been unpredictable in consistently controlling postoperative alterations in bony morphology in many patients. Consequently, a detailed algorithm for an individualized approach to osteotomy is needed to achieve superior aesthetic and functional…”

Excerpt; the full abstract is on PubMed.