Open or Closed Rhinoplasty?
While information of nose surgery has become ubiquitously available, not all surgeons have all the answer— and many mysteries still remain. Patients need stay in the know of different nose surgery techniques to allow them to make a well-informed decision.
The evolution of the rhinoplasty surgery has developed from destructive techniques to conservative, protective and restorative techniques in recent decades.
Let’s explore the options of nose surgery techniques—from the most common to the least used.
Popular nose surgery techniques
There are two main incision techniques in a nose surgery: the open rhinoplasty and the internal (endonasal) rhinoplasty.
As the name suggests, incisions in open rhinoplasty are made outside the nose with a small access incision on the underside of the nose between the nostrils that then connects with other incisions concealed inside the nose.
One of the main advantages of open rhinoplasty is the better visualization this technique provides of the nasal structures. Moreover, it yields a more direct access for surgical manipulation—the small scar at the base of the nose is invisible once it heals. The improved accuracy, versatility and effectiveness of the open rhinoplasty approach make open rhinoplasty most preferred nose surgery techniques.
The advent of open rhinoplasty has miraculously revolutionized the treatment of complex nasal deformities including cleft-lip rhinoplasty, twisted noses or serious post-rhinoplasty deformities. It also makes for a viable solution for difficult nasal anatomy of any type—and many of the most effective techniques of contemporary rhinoplasty can only be carried out through the open approach.
Endonasal rhinoplasty: the closed approach
Also known as endonasal rhioplasty, rhinoplasty closed incisions are positioned inside the nostrils. Because these incisions are hidden, they are virtually invisible after surgery. After the incisions are made, the skin is lifted from the underlying cartilage and bone, and the nose is then re-contoured and reconstructed.
The endonasal approach permits more limited dissection of nasal tissues, offers improved visualization of nasal structures—and eliminates the visible scar at the base of the nose.
Although parallel incisions encircle nearly half of the nostril lining, no part of the incision can be seen externally, hence a visible scar is avoided.
Open or closed rhinoplasty?
Perhaps one of the most puzzling decision nose surgery patients are faced with is the choice of open versus closed rhinoplasty. The appropriate technique- be it open or closed- really comes down to the complexity and patient’s unique condition, aesthetic goals, as well as the surgeon’s level of experience and expertise.
Some surgeons who are adept at open rhinoplasty prefer this approach and can achieve excellent results. When deciding which rhinoplasty approach is appropriate for you, it’s essential to focus on your goals and objective of the surgery.
Most patients would prefer the procedure that results in no visible scarring. The emphasis should not be on whether or not you have a scar, but more on the whole surgical result.
In conclusion patients seeking rhinoplasty are best accommodated when the surgeon has extensive experience in both methods and choose the suitable technique based on patients’ goals rather than his own prejudice or preference.
Most individuals requesting a rhinoplasty are good candidates for a closed technique and can expect such an approach to be offered to them by an experienced rhinoplastic surgeon. Closed rhinoplasty affords the benefits of less recovery time and swelling; as for open rhinoplasty, it can be opted for in cases of complex structure or variation in nasal anatomy.
Other nose surgery approaches:
In addition to the aforementioned surgery incision options, there are various treatment methods for augmenting the nose or correcting surface deformities.
Nasal implants and fillers
Autogenous cartilage grafts are the most common treatment technique in nasal augmentation. The autologous cartilage grafts are usually taken from the nasal septum—which promise the best chance for a natural result.
If cartilage and bone have already been removed from the nasal septum, then ear or rib cartilage and sometimes bone from the skull are the best alternative.
The most obvious reasons for autogenous cartilage graft success and preferred choice among surgeons include ease of use, availability and biocompatibility.
The cartilage provides good structural support while keeping the consistency of the normal nasal cartilaginous skeleton.
Although solid silicone implants can be used for nasal surgery, these are considered foreign materials that may become infected or become incompatible with nasal tissues and have to be removed.
Hence, natural cartilage, if a supply is available, is the most suitable option for nasal implants surgery. In some cases fillers or fat grafts may also be injected to streamline the nose shape, to mask deformities or indentations, or to increase volume in desired areas.
By consistently pursuing a thorough evaluation of each surgical outcome, and by continually improving nose surgery techniques to meet patient’s expectations, plastic surgeons have substantially advanced nose surgery methods.
As a result good surgical outcomes are now the norm.