Revision Rhinoplasty Finesse with Digital Osteotomies

Lisiecki JL, Chiodo MV, Rohrich RJ.

What this paper says

A short technique note stating that in revision rhinoplasty where the nasal bones were already cut once, they can often be moved again by finger pressure alone rather than with a chisel.

Overview

Revision rhinoplasty is described as a finesse procedure requiring care at every step. Lateral osteotomies, cuts along the side walls of the bony nose, are needed in many revision cases. The authors point out that when those cuts were made at the original operation, the old fracture lines can often be reopened with digital pressure, meaning pressure from the surgeon's fingers, without using an osteotome.

Sections of note

Article type: brief technique note. No patient numbers, outcomes or complication data are reported.
Setting: revision rhinoplasty in patients who have already had lateral osteotomies.
Technique: recreating the previous lateral osteotomy using finger pressure alone.
Stated advantage: decreased creation of dead space under the skin.
Stated advantage: preservation of the attachments between the nasal skeleton and the overlying soft tissue.
The abstract gives no criteria for which cases are suitable, and no failure rate for the technique.
No comparison with conventional osteotome technique is reported.

What it means for a patient

If your nasal bones were cut in a previous operation, the old fracture lines may still be the weak point, so less force is needed to move them again.
Dead space is the empty pocket left under lifted skin, where fluid and blood can collect, so avoiding it should mean less swelling.
Keeping skin attached to the bone underneath helps the skin settle back onto the new shape rather than draping over a gap.
The abstract carries no findings. It reports no rates and does not show the technique produces better results.

Why this paper matters

Revision rhinoplasty works on scarred tissue with an unpredictable blood supply, so every step that avoids further dissection has value. Reusing the previous fracture line is a low cost way to do that. Whether it produces measurably less swelling or better contour is untested here.

Terms

Revision rhinoplasty: a second operation to correct the result of an earlier one.
Lateral osteotomy: a cut along the side wall of the bony nose, used to move it inward.
Osteotome: a chisel used to cut bone.
Digital pressure: pressure applied with the surgeon's fingers.
Dead space: an empty pocket under lifted tissue where fluid can collect.

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

From the abstract

“Revision rhinoplasty is a finesse procedure requiring careful consideration of all of its requisite steps. Lateral osteotomies are required in many cases and, in the setting of prior lateral osteotomies, can often be recreated with digital pressure alone, without the use of an osteotome. The advantages of doing so…”

Excerpt; the full abstract is on PubMed.