Closed rhinoplasty

Nasal surgery operations are performed using closed or open rhinoplasty access. Discussions about the best rhinoplasty option continue not only in rhinosurgery forums, but also in the community of plastic surgeons. Some experts believe that most problems of a cosmetic and/or functional nature are best solved with a closed rhinoplasty; others have a different point of view and more often operate on patients with an open method.

photos before and after closed rhinoplasty

Which method is better - open or closed rhinoplasty? The proposed publication deals with the main features of each variant of access to rhinoplasty, the main advantages of the methods and their disadvantages.

general informations

The main difference between the considered methods is the location of the surgical approach. Closed rhinoplasty is performed through internal access. The incisions pass through the mucous membrane of the nasal passages, the skin of the wings and columella is not damaged. With this option, the plastic surgeon actually gets two independent accesses to the deep anatomical formations of the left and right halves of the nasal skeleton, which somewhat worsens the visibility of the surgical field.

Open rhinoplasty is performed externally. The incisions go through the skin of the thin septum between the nasal passages (called the columella) and the wings. A longer and above all continuous incision allows the plastic surgeon to move the skin from the tip to the bridge of the nose and to have an excellent view of the internal anatomical structures (cartilage, bone) that need to be modified. After correction, small scars remain at the level of the incisions, which eventually become almost invisible.

Open plastic: features of the method

According to patients, the main disadvantage of open rhinoplasty is that after correction small scars remain on the skin of the caudal parts of the nose. Although the postoperative scars are barely noticeable and almost impossible to see after the rehabilitation period is over, many are confused by the very fact of their presence. This forces patients to look for specialists who are ready to perform a correction in a closed manner.

For a plastic surgeon, the minimization or complete absence of visible scars on the skin is also of no small importance, but other features of the technique come to the fore for a specialist. Open rhinoplasty is associated with damage to the columella, which is a very significant disadvantage, not only in terms of healing, but also in terms of the long-term aesthetic consequences of the surgical intervention.

Why is damage to the thin skin bridge between the nasal passages important? The columella performs important functions. Inside this anatomical formation are blood vessels - arteries, veins - through which nutrients and oxygen enter the distal tip of the nose.

Columellar arteries are responsible for tissue trophism, and therefore their safety during plastic surgery affects the dynamics of the recovery period. The columellar veins drain venous blood. Their damage results in deterioration of drainage function and increased congestion, which is manifested in greater severity and persistence of swelling at the tip of the nose after surgery.

The second aspect is related to the fact that the columella performs a supporting function. It is a kind of "support" that keeps the tip in the correct anatomical position. During an open operation, the supporting function of the columella can be impaired, which in theory (and in practice) in the long to medium term can lead to an aesthetic complication in the form of subsidence of the tip.

Thus, the main disadvantages of open rhinoplasty are:

  • Columellar arteries are damaged, which worsens the dynamics of the recovery period, increases the severity and duration of edema.
  • The supporting function of the columella deteriorates, leading to the risk of an aesthetic complication in the form of tip droop.
  • Small scars remain on the skin.

There is an open method and advantages. The key is that a continuous and extensive (relatively extensive) incision allows the surgeon to completely open the operative field and have good access to the anatomical formations of the nasal skeleton. When complex manipulations on deep elements are necessary, a good view of the operating field plays a decisive role. It is very important during secondary or reconstructive correction after a severe fracture, and therefore such interventions are almost always performed in an open manner.

Closed Method: Features

Are the pros and cons of closed rhinoplasty a mirror image of the pros and cons we talked about in the previous section? To a certain extent, it is.

Closed rhinoplasty comes with less soft tissue trauma. The columella is not dissected, respectively, the veins and arteries that supply nutrients and oxygen, and through which tissue fluid is drained from the tip, are not damaged. As a result, after closed rhinoplasty, recovery is usually faster. The edema is less pronounced and it passes faster.

The risk of cosmetic complication in the form of tip sag is much lower. There are no visible scars on the skin, which for many patients becomes a decisive argument in favor of closed rhinoplasty.

Advantages of the closed method:

  • Less bleeding, less pronounced damage to the soft tissues of the caudal parts of the nose.
  • The arteries and veins responsible for the blood supply to the tip are not damaged.
  • The support function of the columella is preserved, there is no risk of the tip falling off after correction.
  • There are no scars on the skin.
  • Recovery after surgery is faster. Edema is less pronounced and passes faster.

The disadvantage of the closed method is its limited capabilities. Yes, many aesthetic problems can be solved with a closed operation, but unfortunately not all of them. Revisionplasty requires a full view of the operating field and therefore in repeat operations open rhinoplasty is most often used.

Tip plasty, despite its apparent simplicity, also often requires the use of an open incision. If it is necessary to install large grafts to mold the shape and correct a defect, the surgeon must use external incisions, because sometimes it is not possible to install large implants internally.

The choice between open and closed rhinoplasty is largely determined by the specifics of the problem with which the patient turned to the plastic surgeon. If a high aesthetic result can only be achieved with external incisions, the surgeon chooses the open method. If the correction can be carried out through both external and internal incisions, a closed operation is preferable.

You will receive detailed information about the characteristics, disadvantages and advantages of closed and open rhinoplasty during a one-on-one consultation with a plastic surgeon.