APS Aesthetic Plastic Surgery · 2018

Medial Osteoectomy as a Routine Procedure in Rhinoplasty: Six-Year Experience with an Innovative Technique

Lykoudis EG, Peristeri DV, Lykoudis GE, Oikonomou GA.

What this paper says

In 135 rhinoplasty patients, removing a strip of nasal bone with a pair of pliers instead of cutting it with an osteotome and hammer gave favorable results in 98.5 percent, with 2 patients needing revision.

Overview

Medial osteotomy, the inner bone cut, is part of most rhinoplasties and causes complications and contour problems when done badly. The authors replace the traditional chisel-and-hammer cut with pliers that remove a controlled strip of bone. This paper reports their series and briefly reviews the existing literature.

Sections of note

135 patients underwent rhinoplasty for aesthetic deformities using the described technique.
Two variants were used: type I for dorsal hump reduction with slight narrowing, and type II for a wide nasal dorsum with or without hump removal.
Assessment was by clinical examination and comparison of before and after photographs.
Favorable results in 98.5 percent of patients.
Two patients with wide nasal dorsums had inadequate narrowing and underwent successful revision surgery.
The authors state the technique is easy to perform with a short learning curve, gives high accuracy over the location and amount of bone removed, and inflicts minimal trauma. Level of evidence IV.

What it means for a patient

Bone at the top of the nose is removed rather than fractured, which the authors say makes the amount more controllable.
Only 2 of 135 patients needed a second operation, both for a nose that remained too wide.
Limits: 135 patients, one team, no comparison group against conventional osteotomy, outcomes graded by the treating surgeons from photographs, and no stated follow-up duration.
No bruising or swelling measurements are reported, so the claim of minimal trauma is not quantified here.

Why this paper matters

Osteotomy technique influences bruising, swelling, and the final width of the nose, and remains one of the least standardized steps. Substituting a removal for a fracture is a substantive change in approach. A controlled comparison would be needed to show it reduces complications.

Terms

Medial osteotomy: The inner cut through the nasal bone, near the midline.
Osteoectomy: Removal of a segment of bone, as opposed to only cutting it.
Osteotome: A chisel-like instrument used with a mallet to cut bone.
Nasal dorsum: The bridge of the nose.
Learning curve: How long it takes a surgeon to become proficient at a technique.

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

From the abstract

“Medial osteotomy is an integral part of most rhinoplasty procedures, and when improperly performed, it is associated with postoperative complications and nasal contour deformities. In this article, we present a minimally traumatic and easy-to-perform medial osteoectomy technique with a pair of pliers, as a routine…”

Excerpt; the full abstract is on PubMed.