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Closed and Open Rhinoplasty Techniques Fayetteville

There are two basic approaches to aesthetic rhinoplasty. One is termed “open rhinoplasty technique” and the other is termed “closed rhinoplasty technique”. The “closed rhinoplasty technique” was ubiquitously performed for aesthetic rhinoplasty for many years with good results. The “closed rhinoplasty technique” was preferred at that time to avoid external scars. During this period it was not specifically referred to as the “closed technique” because there was no other commonly performed “open technique” to compare. With the “closed rhinoplasty technique, the incisions were made inside the nose so there was no visible external scar. The disadvantage of this technique was that the procedure was done “blind” (to some degree), meaning that it was done by “feel” and not sight. Another distinct disadvantage is that complex surgical maneuvers used to shape the nose were impossible due to lack of access and exposure. The “open rhinoplasty technique” was used during this period of time but was primarily used for congenital defects and trauma patients. Recently, the “open rhinoplasty technique” has gained wide acceptance and is used for routine rhinoplasty procedures.

Incisions for “closed rhinoplasty”

Incision for “open rhinoplasty”

The “open rhinoplasty technique” has an external incision in the columella (between the nostrils just under the nasal tip). The advantage of the “open rhinoplasty technique” is the ability to perform the rhinoplasty procedure under direct vision, meaning the surgeon can directly see the structures that are being altered. Many surgeons feel that this allows more accuracy and predictability with the rhinoplasty procedure. It also allows more options to alter the nasal skeleton which gives superior aesthetic results, especially in more challenging cases. One disadvantage of the “open rhinoplasty procedure” is the external visible scar, although in many patients the scar will virtually disappear. Even if the scar does not disappear, its location in the columella makes it very inconspicuous. Many surgeons feel that the advantages of direct vision of nasal structures during the rhinoplasty procedure far outweigh the disadvantage of an external scar. Another perceived temporary disadvantage is temporary prolonged edema (swelling) of the nasal tip. Many surgeons feel that the advantages of direct vision of nasal structures during the rhinoplasty procedure far outweigh the temporary swelling that may occur in some patients. As a result, many surgeons that use the “open rhinoplasty technique” do not feel that the perceived increased swelling is of any consequence. Another potential problem with the “open rhinoplasty technique” is compromised blood supply to the tissues. This should always be considered when the “open rhinoplasty technique” is chosen.

“Open rhinoplasty” also allows the Plastic surgeon to accurately “defat” the nasal tip when this is indicated. In some patients there is relatively thick area of fat under the sin of the nasal tip. This ancillary procedure may be used when the patient has thick nasal skin and more definition in the nasal tip is desired. “Defatting” in this context does not mean removal of all the subcutaneous fat. In this contest, “defatting” means thinning or reducing the thickness of the fat. Some thickness of fat should be left behind to allow smooth contours and most importantly, maintain circulation to the nasal tip. If the nasal tip is “defatted” by feel with the “closed rhinoplasty technique” circulation problems can occur because too much fat was removed. Further, because the “defatting” is imprecisely done by feel, contour irregularities and asymmetry may occur.

As with all Plastic surgery procedures, no single technique is best for every patient. There are no hard and fast rules about which technique should be used in which situation. The best technique for a particular patient depends on many factors, some of which are in the table below. The aforementioned are general considerations for choice of technique. The surgeons experience level is also a factor in which technique that is chosen.

Indications for Choice of Rhinoplasty Technique

Closed technique
Open technique

Simple nasal tip changes
Complex nasal tip changes

Simple dorsum changes
Complex dorsum changes

Dorsum is symmetrical
Dorsum is asymmetrical

Tip is symmetrical
Tip is not symmetrical

Grafts not needed
Grafts needed

No previous surgery
Previous surgery (revision)

Thick nasal skin
Thin nasal skin

Patient concerns about external scar
No patient concerns about external scar

No history of trauma
History of trauma