Open-roof deformity
Taking a hump off removes the roof of the nose along with it, leaving the cut edges of the two nasal bones facing the sky with a flat gap between them, the open roof. Closed at the same operation it is a step in the procedure. Left open it is a wide, flat bridge with palpable edges, and in time the cartilage below falls in and it becomes an inverted-V.
What repeats
Four findings that hold across the literature.
It is created deliberately and has to be closed deliberately
Every hump reduction that removes bone opens the roof. The conventional closure is lateral osteotomies, which mobilise the nasal bones and bring them together over the gap. The open roof is therefore not a complication of technique so much as an unfinished operation.
Rests on: Rohrich et al., component dorsal hump reduction · Taş, bone dust in 240 patients.
Osteotomies are not always available
A narrow bony vault makes lateral osteotomies problematic, closing the gap would leave the nose too narrow. Two published alternatives exist for that patient: filling the gap with bone dust harvested during the reduction, reported in 240 patients; and avoiding the open roof in the first place with autospreader flaps, which preserve the full length of the upper lateral cartilage under the nasal bone so the roof is reconstituted rather than closed.
Rests on: Taş · Arslan et al., no-osteotomy rhinoplasty.
The bone it cuts through is not uniform
Bone thickness varies along the osteotomy path, thickest at the middle of the lateral line, thicker in men, and thicker on the deviated side of an asymmetric vault, which a third of patients have. That is the anatomy an osteotomy is being planned against.
Rests on: Kim et al., the bony vault on CT.
Preservation never opens it
Dorsal preservation lowers the intact roof from below. Avoiding the open-roof deformity is named as one of its stated advantages in the comparative literature, and hybrid descriptions combine preservation of the roof with internal spreader grafts where a deviation still needs correcting.
Rests on: McCleary et al. · Öztürk, external strip and internal spreader · and preservation rhinoplasty.
By how it is closed
Four routes, and what each one costs.
Lateral osteotomies
The standard: the bones are cut low-to-high and mobilised inward until the edges meet. It narrows the bony vault as well as closing the gap, which is usually wanted and occasionally not.
Rests on: Rohrich et al. · Kim et al..
Bone dust
The dust and small fragments produced by rasping are collected and packed into the gap. Described across 240 patients in four steps built around a complete submembranous dissection and spreader flaps. It is the answer for the narrow vault where osteotomies would over-narrow.
Rests on: Taş.
Autospreader flaps, so no roof is opened
In component reduction the whole length of the upper lateral cartilage is kept, including the part under the nasal bone, and folded inward. Where the only reason for an osteotomy was to close the roof, this removes the reason.
Rests on: Arslan et al. · and dorsal hump reduction.
Not removing the hump at all
Preservation lowers the intact osseocartilaginous roof, so there is nothing to close. Its own failure mode is the hump coming back.
Rests on: McCleary et al..
What to ask about an open roof
Questions the evidence supports asking.
Are osteotomies part of my plan, and why?
If a hump is coming off, ask how the roof gets closed. "Osteotomies" is the usual answer; "autospreaders" and "bone dust" are the published alternatives, and each is chosen for a reason that should be about the shape of the bony vault.
Rests on: Taş · Arslan et al..
Will my nose end up narrower than I want?
Lateral osteotomies close the gap by narrowing the bony vault. In a nose that was already narrow that is the trade the alternatives exist to avoid.
Rests on: Taş.
Can I feel a step on the bridge?
A palpable edge along the dorsum after a hump reduction is the open roof presenting itself. It is worth raising early, because it is a different problem from the swelling that resolves.
Rests on: recovery.
Is this going to become an inverted-V?
An unclosed roof and unsupported upper lateral cartilages are the two halves of the same failure. Ask whether the middle vault was rebuilt as well as the bones brought together.
Rests on: inverted-V deformity · Rohrich et al..
The terms, defined
The words used about this deformity.
- Open-roof deformity: the flat gap between the cut nasal bones after a hump is removed and the roof is not closed. [15457053]
- Lateral osteotomy: the controlled cut that mobilises the nasal bone so it can be moved inward; usually in a high-low-high line. [36594157]
- Bone dust: bone collected during rasping and packed into the gap instead of closing it with osteotomies. [29879004]
- Autospreader (spreader flap): the upper lateral cartilage folded inward, preserving the roof rather than closing a gap. [24310581]
- Bony vault: the paired nasal bones; asymmetric in about a third of primary patients. [36594157]
- Submembranous dissection: the plane the bone-dust technique is built on, keeping the periosteum and mucosa intact. [29879004]
Where else this is documented
Sources outside the journals, each one free to read.
The national guideline
The American Academy of Otolaryngology published a clinical practice guideline on nasal form and function after rhinoplasty, with a plain language summary written for patients. It sets what a surgeon should assess and document when the profile is being lowered.
Rests on: the clinical practice guideline · the plain language summary.
The surgeons' own textbook chapters
Rhinoplasty Archive, the free online rhinoplasty textbook edited by Daniel G. Becker, carries chapters on the osteotomies that close the roof and on the midvault work that goes with them. They are written for surgeons and go further into technique than a patient page should.
The reference summary
Rhinoplasty in StatPearls, on the National Library of Medicine's Bookshelf, sets out the osteotomy types and the complication list in free full text.
The societies
- American Society of Plastic Surgeons, patient information.
- American Academy of Facial Plastic and Reconstructive Surgery, patient information.
- The Rhinoplasty Society, the surgeons' body, with its member directory. See associations.
The trials in progress
How the bony vault is cut is under test in a registered trial.
- Hybrid Osteoplasty Versus Osteotomy in Rhinoplasty, active and not recruiting, 200 participants.
What is not settled
- The bone-dust series is 240 patients under one surgeon with no comparison against osteotomy. [29879004]
- No study tests how often an unclosed roof becomes a visible inverted-V, or over what period.
- Osteotomy technique is described in terms of anatomy rather than outcome: the CT work maps bone thickness and asymmetry but no series tests whether cutting each side differently changes the result. [36594157]
- Whether preservation's avoidance of the open roof holds up beyond twelve months is untested. [40331571]
Written by rhinoplasty.cc from the sources linked above, 2026-09-09.
Who publishes on revision and secondary rhinoplasty
Ranked surgeons with papers under this topic in the archive, most first.
Rod J. Rohrich (8) · Dean M. Toriumi (7) · Samuel Lin (5) · Richard E. Davis (4) · Sam P. Most (4) · Michael Lee (3) · Paul Nassif (2) · Angela Sturm (1) · Anil Shah (1) · Anita Patel (1)
The literature: Revision and secondary rhinoplasty, 181 papers. Video: Revision and secondary, 322 videos. Every technique.