Will There Be A Scar On My Nose After Open Rhinoplasty?
3 December 2019 onur
This is one of the most confusing issues for rhinoplasty candidates. Surgeons who do open rhinoplasty say there will be none, while surgeons who perform closed rhinoplasty say there will be some. Well, both groups are surgeons, and there’s no way any of them will lie, right? This article is for you if you are one of those wondering who to believe.
First, we need to thoroughly define what a “scar” is. In plastic surgery, “scar” is the common name for all physical symptoms that allow an operation to be noticed by an outsider. When we refer to a surgical “scar”, we mean all the signs showing that the person has had surgery.
When we refer to “scars” in rhinoplasty, what is often meant is incision marks due to skin or mucosa incisions.
Let’s list these scars.
- An incision scar of 4-6 mm in length, crossing through the middle of the tissue bridge (columella) separating the two nostrils.
This scar is the entrance scar used when separating the nasal soft tissues from the skeleton in open rhinoplasty. We do not see this part of the nose from the opposite, so a scar here is outside of our visual attention in daily communication. Since wound healing in this area is very good, if it is sutured with care, the thickness of the scar here will be less than 0.5 mm. During secondary surgeries, I have difficulty seeing these scars even when I search for them under bright surgical lights with magnifying surgical glasses. However, if there is a level difference between the surgical wound lips during suturing and if the very delicate tissue here is damaged by the rough technique, the scar may be evident and may need to be handled again in a second session.
- The incision scar at the junction of the nasal skin and nasal mucosa on both sides of the columella.
This scar corresponds to the place where the first scar above curves from the sides towards the inside of the nose. While this scar is limited to the upper half of the columella in the open technique, the scar often needs to cross the columella from one end to the other when the cartilages are delivered and shaped outside in the closed technique. If due care is not taken, this scar can be seen from the outside in patients who have undergone closed rhinoplasty.
- Incision scar in the groove where the wings and cheek meet in cases where wings are reduced.
If the nostrils or wings are large and these structures need to be reduced during surgery, it is impossible to do this without leaving a scar on the skin. This scar is the most obvious of the scars left on the skin after nose surgery. If the wings are to be reduced in both the open technique and the closed technique, this scar will remain in any case.
- Incision scars left on the skin by the metal bone cutter called an “osteotome”.
One of the bone shaping techniques in nose surgery is to shape the bones directly over the skin with a very thin metal chisel. In this technique called percutaneous osteotomy, incision scars may remain on the skin up to the thickness of the instrument used (1-2 mm). Since this technique is preferred by some of the physicians who perform both open and closed rhinoplasty, these scars may occur after surgery in both techniques. However, these scars will also be invisible after a healing process of 3-6 months.
Depending on the techniques used in open rhinoplasty, all of these 4 types of scars can be seen. On the other hand, these scars heal so gently when the appropriate technique is used that an external eye cannot notice these scars unless they get very close and examine them in a very bright environment.
What most people do not know is that the second, third and fourth scars can also be seen in closed rhinoplasty depending on the techniques used.
Therefore, the sentence “Open rhinoplasty leaves scars, but closed rhinoplasty does not” is not entirely true.
Incision scar or deformity?
If a person who does not know you and sits at the next table can understand that you have had rhinoplasty, it means that they notice it by following some scars. If we had to list the problems which give clues to the observer that the nose has been operated, the incision scars we have listed above would be at the bottom of this list.
The main problem that makes up an operated nose appearance is structural defects (deformities) in the nose. Closed rhinoplasty is an operation that is more prone to post-operative structural disorders because it is performed without “seeing” the skeleton and cartilage structure in the nose. Therefore, it is unreasonable for both physicians and most patients to risk the structural defects that can be seen from the next table in order to avoid a scar that is almost impossible to see in daily life.
Because of these problems, modern closed rhinoplasty surgeons have sought ways to transfer some open surgery maneuvers to the closed technique, resulting in the emergence of hybrid (semi-open) surgical techniques. Even these techniques can be applied effectively only in a limited number of patients and not in every patient. Since most of the surgeons experienced in rhinoplasty today can safely perform both open and closed techniques, it will definitely be wise to leave the decision to your surgeon in choosing the technique that is most suitable for you.
Take good care…
… of yourself and your beauty.