Rhinoplasty 101 part two
around lunchtime of June 28th, 2006Rhinoplasty 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).
Rhinoplasty part three: healing time and realistic expectations….tomorrow!
Dr. Francis R Palmer, III
Rhinoplasty 101 part two…
Let’s continue on yesterday’s discussion of Rhinoplasty Procedures. There are two general types of Rhinoplasty Surgical Procedures: Closed Rhinoplasty and Open Rhinoplasty. Let’s start with Closed Rhinoplasty. Closed Rhinoplasty is a Rhinoplast…
To Lift Or Not To Lift :: 5 months, 3 weeks after
Hello- I’ve sent a message before but I’m having trouble with it posting. I had a rhinoplasty, open, to reduce a small dorsal hump and to reduce the round shape of my tip. Its not 2 weeks out and my bridge and nose overall seems wider then ever. Is this swelling? How long will it take to thing out? If my PS hasn’t discussed with me, how can I bring up the option of kenalog? Can a skilled dermatologist administer that or do u recommend the PS? Would that help to think out the bridge and fleshy tissue around my nose?
Looking forward to hearing from you.
Alexis :: 1 year, 3 months after
Hello,
It’s been 2 1/2 weeks since my rhinoplasty. I’m a little worried because the tip is still swollen which I hear is normal. My question is, today for some reason I forgot about the surgery for a split second and rubbed the right side of my nose by the nostril area. I still feel where I did it. It does not hurt. Do you think this will have a negative impact on the outcome of my new nose? Please let me know. Thank you so much for your time.
CIN :: 1 year, 7 months after
CIN,
If you are concerned that you injured your nose after your Rhinoplasty, you should contact the office of the plastic and cosmetic surgeon that performed your Rhinoplasty and explain to them what happened. Let them determine if you did or did not hurt your nose.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 8 months after
…I’m curious, The top doctor in Seattle WA , does ONLY closed and seems to be the one everyone here goes to. YET, It seems like his after results are way crazy, as if it was an open rhinoplasty? I see some sites say oh no it’s not possible, but some sites say yes yes it’s possible if your surgeon is good at what he does?
Most of the pictures on his site the tips were too droopy, or long.. and the after pictures look pretty good.
Or are their noses not as complex as you mean?
Rebma :: 1 year, 10 months after
Rebma,
In my opinion, Rhinoplasty Surgeons should be well trained and experienced in Open and Closed Rhinoplasty techniques. I’ve always believed that I should control what the Rhinoplasty technique does not vice versa and if you only do one type of Rhinoplasty technique (closed or open), you are limited by whatever that particular technique can acheive. Why would you, as a plastic and cosmetic surgeon do that?
In this blog and on my website, I’ve written many times that any perspective Rhinoplasty patient should select a plastic and cosmetic surgeon that is well experienced in all techniques of Rhinoplasty surgery both open and clsoed and be comfortable mixing portions of both techniques to accomplish the required goals.
As far as the Rhinoplasty surgeons in your area, whether it’s Seattle or Dallas or Miami…if you don’t get a warm fuzzy feeling from the Rhinoplasty surgeons in your area….FLY ELSEWHERE. It’s much less hassle and expense than getting a Revision Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 10 months after