Date: April 24, 2002
Conference: 4th Korea-Japan Plastic Surgery Academic Meeting (Shilla Hotel, Seoul)
Title: A New Technique for Narrowing a Wide Nasal Bone through Direct Percutaneous Approach

Introduction

Asian noses often appear broad and less refined due to a wide nasal bone. Simply increasing the height of the nose without reducing the bony width can look unnatural and imbalanced. Although traditional osteotomy methods exist, they often result in significant bleeding, swelling, and bruising, typically requiring general anesthesia—factors that lead many surgeons to omit bony narrowing. Some have tried shaving the lateral aspects of the nasal bone instead of performing an osteotomy, but this approach is less effective for truly narrowing a wide nasal base. Therefore, a more efficient osteotomy with minimal bleeding and swelling is needed.

Surgical Method and Instrumentation

In conventional lateral osteotomy, a broad guide is used through an internal nasal approach, starting below the nasal bones and moving upward. The wide guide often injures the nasal mucosa, blood vessels, and surrounding soft tissue, leading to heavy bleeding, extensive bruising, and prolonged recovery.

By contrast, this new technique employs a 2–3 mm micro-osteotome used percutaneously at a 90° angle from just above the dorsum. Upper and lower osteotomies are performed with precision, eliminating the need to enter through the nasal mucosa and significantly reducing soft-tissue trauma.

Results

• Minimal Damage: Because the nasal mucosa remained intact, bleeding and bruising were notably reduced, allowing for a faster recovery.
• Improved Accuracy: The osteotomy lines were more precise, with fewer irregularities.
• Anesthesia Considerations: Approximately 75% of cases were done under sedation, and 25% under general anesthesia.

Discussion

Traditionally, narrowing a wide nasal bone in Asian patients could involve general anesthesia, heavy bleeding, significant swelling, and a long recovery, causing many surgeons to skip osteotomies altogether. At this joint Korea-Japan Plastic Surgery conference, Dr. Myung-Ju Lee introduced a new, simpler method for bony narrowing. Its advantages include:

1. Option of Local Anesthesia: Reduces the need for general anesthesia.
2. Less Postoperative Morbidity: Minimal swelling, bruising, and faster recovery.
3. Enhanced Precision: A direct percutaneous approach with a small osteotome allows for more accurate and predictable outcomes.

By going beyond mere dorsal or tip augmentation to address the nasal bone width, this technique enables a more balanced, comprehensive rhinoplasty result—improving both function and aesthetics.