Rhinoplasty 101 part two

June 28, 2006 drfpalmer 6 comments

Rhinoplasty 101. Let’s continue on yesterday’s discussion of Rhinoplasty Procedures ( http://www.drfpalmer.com/Rhinoplasty.html ). There are two general types of Rhinoplasty Surgical Procedures: Closed Rhinoplasty and Open Rhinoplasty. Let’s start with Closed Rhinoplasty. Closed Rhinoplasty is a Rhinoplasty Procedure that has all of its incisions within the nostrils. Offhand, you may assume that this wouldn’t make any difference when doing a Rhinoplasty, but that would be a false assumption.

Closed Rhinoplasty, in my opinion, is limited in certain clinical situations because of the fact that the central part of the nasal tip skin is not dissected and remains attached. This means that the nasal tip cartilages can not possibly be viewed as they normally exist, within the nose, nor can they be sutured or manipulated in place. They ( the nasal tip cartilages ) must be drawn down through one of the nostrils in order to access the center of the nasal tip cartilages during a Closed Rhinoplasty.

So, what’s the big deal you ask? If you don’t have a nasal tip that is wide and boxy, asymmetric, or has had previous Rhinoplasty performed on it….it doesn’t matter because the chances are that the nasal tip cartilages will not require extensive manipulation and correction within this central cartilage region of the nasal tip…and that’s excatly the type of Rhinoplasty case when I use a Closed Rhinoplasty. The noses that don’t require extensive and complicated sewing, shaping and/or placement of tip cartilage grafts (these require direct visualization and sewing in position) may have a Closed Rhinoplasty. Oh, and of course in Revision Rhinoplasty where the nasal tip will require anything other than the most minor modifications along the superior aspect of the nasal tip and upper lateral cartilage junction. In all other situations, in my opinion an Open Rhinoplasty is required.

Now, you’ll see that I never mentioned removing a large bump, hump or otherwise manipulating the rest of the nose framework in my determination of when to perform an Open Rhinoplasty versus a Closed Rhinoplasty. That’s because the rest of the cartilages and bone of the nose can be adequately changed, augmented and refined using either a Closed Rhinoplasty or an Open Rhinoplasty and since the Closed Rhinoiplasty has fewer incisions ( by just a bit), is easier to perform ( by quite a bit…even for someone like myself with over 16 years of experience of doing thousands of cases), takes less time to perform ( about 2 hours for an Open Rhinoplasty versus 1 hour for a Closed Rhinoplasty), and has quicker healing time ( a fair amount faster for a Closed Rhinoplasty versus and Open Rhinoplasty because less nasal tip skin is dissected)…I would use a Closed Rhinoplasty for any of those manipulations of the nose.

The rub comes when a previous Rhinoplasty, or several previous Rhinoplasties have been performed, the nasal tip is wide and broad ( looks bulbous), or is really uneven and asymmetric…nothing, in my opinion, gives me the ability and the power to correct these things like an Open Rhinoplasty. By making that small seemingly insignificant inverted V incision along the skin of the Columella and connecting that with incisions hidden within the nsotrils, I can now look at the nasal tip structures as they exist at rest. No twisting, no distortion…it’s the way they are. More importantly, I can manipulate, sew and modify these nose structures under direct visulaization. That’s HUGE!

When I combine the curved portion of the ear as a tip graft, I now have the ability to do or redo seemingly impossible nasal tips that are large, twisted, asymmetric or in some other way distorted. Combine that ability with an onlay silicone graft to the nasal bridge and I have the right tools to tackle even the most challenging of noses…and man, I have seen my share of those.

So, the take home message in Rhinoplasty part two is simple: both Closed Rhinoplasty and Open Rhinoplasty are valuable Rhinoplasty techniques and neither is perfect for all cases….so don’t let a Plastic and Cosmetic Surgeon tell you that he/she only does Open Rhinoplasty or Closed Rhinoplasty in every case. You need a Plastic and Cosmetic Surgeon that can and does frequently use both Closed Rhinoplasty and Open Rhinoplasty in order to get the best possible aesthetic result from your nasal surgery (Rhinoplasty).