Nasal surgical interventions are performed with closed or open rhinoplasty access. Discussions about which rhinoplasty is the best option continue not only on the rhinosurgery forums but also in the plastic surgeon community. Some experts believe that most problems of an aesthetic and/or functional nature are better solved with the help of closed rhinoplasty; others take a different view and more often operate on patients using an open method.
Which method is better - open or closed rhinoplasty? The proposed publication discusses the main features of each variant of the rhinoplasty approach, the main advantages of the methods and their disadvantages.
General information
The main difference between the considered methods is the localization of the surgical approach. The closed rhinoplasty is performed through an internal approach. The incisions go 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 approaches 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 through an external approach. The incisions pass 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 shift the skin of the tip of the nose to the bridge of the nose, obtaining an excellent view of the internal anatomical structures to be modified (cartilage, bones). After the correction, small scars remain at the site of the incisions, which eventually become almost invisible.
Open plastic: features of the procedure
The main disadvantage of open rhinoplasty, according to patients, is that after the correction, small scars remain on the skin of the caudal parts of the nose. Although postoperative scars are barely noticeable and almost invisible after the rehabilitation period is complete, many are confused by their mere presence. This forces patients to seek out specialists who are ready to carry out 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 for a specialist, other features of the technique take precedence. Open rhinoplasty is associated with damage to the columella, which is a very significant disadvantage not only in terms of scarring, but also in terms of the long-term aesthetic consequences of the surgical intervention.
Why is damage to the thin bridge of skin between the nasal passages important? Columella performs important functions. Within 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 is fraught with a deterioration in the drainage function and increased congestion, which is manifested by a stronger and persistent swelling of the tip of the nose after the operation.
The second aspect is related to the fact that the columella has a supporting function. This is a "stay" of sorts that keeps the tip in the correct anatomical position. In open surgery, the support function of the columella can be compromised, which theoretically (and practically) can lead to an aesthetic complication in the long or medium term in the form of tip droop.
So, the main disadvantages of open rhinoplasty are as follows:
- Columellar arteries are damaged, which worsens the dynamics of the recovery period, increases the severity and duration of edema.
- The supportive 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 widened (relatively widened) incision allows the surgeon to fully open the surgical field and gain good access to the anatomical formations of the nasal skeleton. When complex manipulations of deep elements are required, a good view of the surgical field plays a crucial role. It is very important in secondary or reconstructive correction after a major fracture, which is why such procedures are almost always performed openly.
Closed Method: Features
Are the pros and cons of closed rhinoplasty a reflection of the pros and cons we talked about in the previous section? To a certain extent it is.
Closed rhinoplasty is accompanied by less trauma to the soft tissue. The columella is not dissected or the veins and arteries that bring nutrients and oxygen and through which tissue fluid is drained from the tip are not damaged. As a result, recovery from a closed rhinoplasty is usually faster. The edema is less pronounced and passes more quickly.
The risk of an aesthetic complication in the form of sagging of the tip is much lower. There are no visible scars on the skin, which is a decisive argument in favor of a closed rhinoplasty for many patients.
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 retained, there is no risk of the tip falling off after the correction.
- There are no scars on the skin.
- Recovery after surgery is faster. The edema is less pronounced and passes more quickly.
The disadvantage of the closed procedure is its limited possibilities. Yes, many aesthetic problems can be solved with closed surgery, but unfortunately not all. Revisionplasty requires a full view of the surgical field, and therefore open rhinoplasty is most commonly used in repeat surgeries.
Also, laceplasty, despite its apparent simplicity, often requires the use of an open incision. When it is necessary to install large grafts in order to model the shape and correct a defect, the surgeon must use external incisions since it is sometimes not possible to install large implants through an internal approach.
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 highly aesthetic result can only be achieved with external incisions, the surgeon chooses the open method. If the correction can be performed by both external and internal incisions, then closed surgery is preferable.
You will receive detailed information on the special features, disadvantages and advantages of closed and open rhinoplasty during an individual consultation with a plastic surgeon.