Hybrid Osteoplasty Versus Osteotomy in Rhinoplasty

Aesthetic and Functional Outcomes Following Hybrid Osteoplasty Versus Traditional Osteotomy in Rhinoplasty: A Randomized Controlled Trial

This study is designed to compare two common techniques for reducing the nasal hump during rhinoplasty: the traditional method using osteotomes and rasps, and a newer technique called hybrid osteoplasty that uses a surgical drill. Both approaches aim to improve the appearance and function of the nose. The trial will measure pain, swelling, bruising, and the smoothness of the nasal bridge, as well as patient satisfaction and breathing outcomes. Participants will be followed for one year to assess both early healing and long-term results.

This prospective randomized controlled trial will evaluate the aesthetic and functional outcomes of hybrid osteoplasty using a surgical burr compared with traditional osteotomy and rasping in primary open rhinoplasty patients presenting with dorsal humps. The study population consists of adults without prior nasal surgery, trauma, or congenital deformities. Patients are randomized into two groups: Group A (hybrid osteoplasty) and Group B (traditional osteotomy plus rasping).

The primary objective is to assess differences in postoperative pain, edema, ecchymosis, dorsal smoothness, contour regularity, and patient satisfaction. Secondary outcomes include functional improvement measured by the Nasal Obstruction Symptom Evaluation (NOSE) score, aesthetic satisfaction assessed by the Rhinoplasty Outcome Evaluation (ROE), and the rate of revision surgery within 12 months.

Follow-up assessments are scheduled on postoperative Days 1, 2, and 7, and at 1, 3, 6, and 12 months. Standardized photographic documentation will support aesthetic evaluation, while clinical scoring systems will provide objective and subjective outcome data. The trial is powered to identify whether hybrid osteoplasty offers advantages in contour refinement and reduced soft tissue trauma compared with conventional osteotomy-based approaches.

Inclusion Criteria:

• Primary open rhinoplasty planned.
• Dorsal hump with bony or mixed component suitable for either technique.
• No prior nasal surgery or significant nasal trauma affecting dorsum.
• ASA I-III and fit for general anesthesia.
• Willing to provide written informed consent, including standardized photography.
• Able and willing to attend all follow-up visits through 12 months.

Exclusion Criteria:

• Revision rhinoplasty or prior osteotomy/osseocartilaginous work.
• Active infection, open lesions, or uncontrolled dermatologic conditions at operative field.
• Bleeding diathesis, platelet disorder, INR elevation, or anticoagulant/antiplatelet therapy that cannot be paused.
• Uncontrolled systemic disease (e.g., hypertension, diabetes) or ASA ≥ IV.
• Pregnancy or breastfeeding.
• Chronic isotretinoin use within past 6 months or long-term systemic corticosteroid use.
• Concurrent interventional study that may affect healing or outcomes.