Nasal bone fractures: When cosmetic surgery can be combined and how to stage the procedure

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce a unique case where we addressed both a nasal bone fracture and a previously overly high nasal bridge.

• 6 years ago: Nose filler procedure, subsequently dissolved

• 4 years ago: Rhinoplasty with autologous rib cartilage and silicone implant

• 1 week ago: Sustained a nasal bone fracture

1. Front view

• Nasal bone severely deviated to the right

• Nasal tip shifted toward the right

• Flared nasal shape

2. Profile view

• Overly high nasal bridge

• Drooping nasal tip

• Retracted columella

3. Nostrils

• Columella deviated to the right

• Nostril asymmetry

• Reduction of the nasal bone fracture

• Lowering the excessively high nasal bridge

• Cosmetic improvement

Figure 1. Classification of nasal bone fracture." from Kim JH, Lee JW, Park CH. Cosmetic Rhinoseptoplasty in Acute Nasal Bone Fracture. Otolaryngology Head and Neck Surgery. 2013;149(2). DOI:10.1177/0194599813487493

https://pubmed.ncbi.nlm.nih.gov/23812981/

Whether nasal bone fracture treatment can be combined with cosmetic surgery depends on the fracture pattern:

• Type I, IIo, IIs: Simple fractures where cosmetic surgery can be performed concurrently

• Type IIIo and IIIs: Comminuted oblique/sagittal fractures that require a selective, careful approach

• Type IV: Multiple comminuted fractures involving the ethmoid bone, where concurrent cosmetic surgery is difficult

This presentation was classified around Type IIIo, so a 2-stage approach was selected:

1. Reconstruction of tip support using autologous rib cartilage alongside nasal bone reduction

2. Planned nasal bridge augmentation with autologous rib cartilage after confirming fracture healing at 3 months

1. Nasal bone fracture assessment

• Assessed as approximately Type IIIo

• Multiple fracture lines identified on CT (including traces from previous osteotomy)

• Formulation of a closed reduction surgical plan

2. First surgery

• Closed reduction performed

• Septal extension using autologous rib cartilage

• Correction of nasal tip deviation

• Implant-free approach to support stability

3. Plan for the second surgery

• Confirmation of stable fracture healing after 3 months

• Nasal bridge correction using autologous rib cartilage

• Final contour refinement

1. Front view

• Improved nasal bone alignment

• Realigned nasal tip position

• Balanced overall contour

2. Profile view

• Prioritized nasal tip and columellar contours

• Securing a stable structure

• Adjustment of nasal bridge height planned through a second surgery

3. Nostrils

• Correction of columellar tilt

• Balanced nostrils

• Stable nasal tip support

This was a notable case where both a nasal bone fracture and aesthetic refinements had to be addressed concurrently. The feasibility of performing cosmetic surgery alongside nasal fracture repair depends on the fracture pattern; because this case was assessed as approximately Type IIIo, a careful and deliberate approach was necessary.

An interesting finding during surgery was that some of the fracture lines visible on CT were actually remnants of previous osteotomies. Through closed reduction, the fracture was stabilized, and the tip deviation was corrected using septal extension with autologous rib cartilage.

Adjusting the nasal bridge height was planned as a second surgery for stability after the fracture healed, which was chosen with patient safety and the intended result in mind. The alignment of the nasal bones and the position of the nasal tip improved significantly with only the first surgery, and completing the final shape is expected through the second surgery after 3 months.

This was Dr. Peter C. Kang. Thank you.

Thank you.

#closedrhinoplasty #nasalfracture #reduction #autologousribcartilage #customrhinoplasty