Rhinoplasty – Open or Closed?
3 December 2019 onur
Before I start this article, I would like you to know that both approaches have undergone key revolutionary changes in the last decade.
The open/closed rhinoplasty we are talking about today and their predecessors 10 years ago represent quite different surgeries.
Over the past decade, both approaches have assumed each other’s peculiar advantages to evolve and are now much more alike.
As of today, both surgeries are based on the same basic principles.
For instance, in modern closed rhinoplasty, the cartilages at the tip of the nose are taken out of the nostrils (delivered) and are directly shaped out of the nose, just as it is done in open rhinoplasty.
In modern closed rhinoplasty approaches, a 3-mm incision is no longer made at the tip of the nose, but thanks to the long incisions inside the nose, the nasal skeleton can be opened completely, just as it is done in open rhinoplasty.
In modern closed rhinoplasty approaches, we use suturing techniques and cartilage grafts that we use in open rhinoplasty to stabilize nasal tip cartilage.
If the nose wings and nostrils are large, we make them smaller, just as it is done in open rhinoplasty.
We cannot use a piezotome in modern closed rhinoplasty, but we cut the bones in a controlled manner instead of breaking them, just as it is done in open rhinoplasty.
In summary, the work done inside the nose is almost the same.
THEN WHAT IS THE DIFFERENCE?
A 3-millimeter incision is made at the tip of the nose, on columella, to be more precise, which is the bridge-shaped tissue between both nostrils. In open rhinoplasty, this skin is incised. In closed rhinoplasty, it is not.
There are one or two capillaries in this area, and they can be preserved in the closed rhinoplasty approach. It is unclear whether there is any benefit in preserving these vessels in the long run.
In closed rhinoplasty, the inner soft tissue and ligament layer of the nose can be completely preserved, while in open rhinoplasty, these layers are restored to the original state at the end of the surgery.
Closed rhinoplasty is generally said to cause less edema and heal faster, but there is no data in the literature to support such observation. Nasal edema may be prolonged after closed rhinoplasty, particularly in patients with thick skin.
The main advantage of open rhinoplasty is that we can employ the piezotome technology for direct visualization and to directly shape the bone structure. This is particularly advantageous in curved noses and secondary cases in addition to cases where significant changes will be made to the bony roof. Ultrasonic piezotome technique in open rhinoplasty reduces the risk of an unexpected problem with the bony roof in a routine surgery.
Furthermore, in the closed technique, a smooth bone structure can be obtained in most cases. However, with the open ultrasonic technique, you will be more likely to obtain a smooth nasal skeletal structure. For instance, if your likelihood to achieve a smooth bony roof in the closed technique is 85%, this likelihood rises to 95% in open ultrasonic rhinoplasty. Evidently, both techniques present a value in the hands of the surgeon who performs them. There are surgeons who apply both techniques successfully with a high success rate.
In summary, there is not a significant difference for you between the two approaches in modern rhinoplasty. I routinely practice both techniques. I am not an advocate or fan of any of the techniques. Both are like my kids.
You can contact me for information about which approach is more appropriate for your nose.
Take good care…
… of yourself and your beauty.