Rhinoplasty essentials

Rhinoplasty is the term for a number of operative techniques that can improve the aesthetic and functional properties of the nose. It is most commonly performed for nose augmentation (building up) or reduction (the most popular form).

See also: revision rhinoplasty

There are two main rhinoplasty techniques – open and closed – and both of these are widely used by surgeons. There are advantages and disadvantages for each method, which have always been a reason for discussion among cosmetic surgeons.

The main difference between the approaches is where the incision is made to access the nasal structure. In open rhinoplasty, the surgeon makes a small incision between the nostrils and then makes additional incisions inside the nose. Closed rhinoplasty involves incisions only in the interior of the nose.

The technique used will depend on the goals and desired results of the patient as well as he surgeon’s preference, and will be decided after careful discussion between the patient and surgeon.

Open rhinoplasty

Open rhinoplasty surgery involves making an incision at the base of the columella, which is the strip of tissue and skin that separates the nostrils. Then the surgeon lifts the nasal skin carefully back in order to be able to work on the cartilage and other tissues inside the nose.

The main advantage of the open rhinoplasty technique is that the surgeon is able to see the inner cartilage network properly and work on the inner structures more precisely and freely. Therefore, open rhinoplasty is often chosen for more complicated cases, when more work is required in order to achieve the desired result. This approach is also beneficial for revision rhinoplasty.

The open technique is helpful in complex cases such as cleft lip operations or when a previous rhinoplasty has left a nose pulled too high and structural grafts are required to bring the nostrils down. In these scenarios, surgeons may prefer the open approach as it offers them greater visibility and access to the internal nasal structures.

Some patients fear that their nose will collapse or look artificial or ‘operated on’. The open technique may be more demanding on the surgeon, however it helps to ensure the basic foundation of the nasal structure is kept strong. In turn, this ensures a more stable shape to the nose after surgery that will resist collapse and maintain a natural shape.

Because an additional incision on the columella is made during open nose surgery, the procedure leaves a small scar on the underside of the nose, but this should be barely noticeable with time. The patient may also experience swelling, bruising and numbness for longer than if the
closed approach is used.

Closed rhinoplasty

Prior to the increased popularity of the external (open) approach in the past few decades, the terms rhinoplasty and closed rhinoplasty were almost synonymous.

During the closed rhinoplasty procedure, the incisions are made inside the nostrils. It is considered to be less invasive than the open technique and the main advantage of the closed rhinoplasty technique is that there is no visible scarring after surgery.

Since closed nose surgery is generally performed to improve minor defects of the nose, the procedure takes less time to complete than the open technique. Usually, closed rhinoplasty may take from one to two hours, whereas open rhinoplasty may last up to four hours.

Healing and recovery time from the surgery is generally faster with closed rhinoplasty. Swelling and bruising can be less dramatic, and typically lasts for a shorter period of time when the closed technique is used. Less numbness of the nasal tip can also be expected. Some surgeons also feel the closed technique offers them a better ability to judge the final shape and contour of the nose as there are no external incisions compromising the appearance of the nose.

The main disadvantage of closed rhinoplasty is its limited use. It is generally best for people who only require minor modifications. For example, a small hump can be corrected, but the patient should be satisfied with other characteristics of their nose.

While it may not offer quite as much freedom to the surgeon, closed rhinoplasty still allows plenty of reshaping possibilities. Bone and cartilage can be removed or, in some cases, taken from another part of the patient’s body and added in for better shape or support.

Whichever approach is chosen, the key to any successful rhinoplasty is to address each patient’s individual anatomy, concerns and goals.