Can A Revision Rhinoplasty Rewiden My Nasal Bones?

Q: Dr. Eppley,I’ve had a bad experience with a primary rhinoplasty making my nose too thin, specially in the upper area where my eyes are (T shaped). I believe the cause of this is overly aggressive osteotomies. I have morphed a picture where I make the upper third of the nose wider (Y shaped). Would you mind telling me if this is possible with a revision? Thank you for your time. Looking forward to hearing from you.

A: The nasal bones can not be recut and expanded to create that shape in the upper nose. A revision rhinoplasty using outward osteotomies is not stable and will not hold even if they could be cut to make that shape. Widening the nasal bones is hard enough but to make the nose have a T-shape (or return to it) would be impossible by just moving the nasal bones. The only way to create that shape would be by adding a material or graft to the outside of the nasal bone. That could most easily and assuredly be done by making a small custom implant to fit over the radix to create that exact shape using a 3D CT scan. This is a perfectly safe place for a small nasal implant. It could also be done using graft materials such as cartilage, bone or acelluar dermis but there are shaping/contour concerns with this type of revisional approach and issues of symmetry and smoothness would be a concern.