Rhinoplasty is performed with closed or open rhinoplasty. Discussions on which rhinoplasty option is better continue not only in rhinoplasty forums, but also in the community of plastic surgeons. Some experts believe that most aesthetic and / or functional problems are better treated with closed rhinoplasty; others have a different point of view and more often operate on patients in an open manner.
Which method is better - open or closed rhinoplasty? The proposed publication discusses the main features of each variant of rhinoplasty access, the main advantages of the methods and their disadvantages.
General Information
The main difference between the methods considered is the localization of the surgical approach. Closed rhinoplasty is performed through an internal entrance. 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 has two independent entrances to the deep anatomical joints of the left and right halves of the nasal skeleton, which slightly impairs the vision of the surgical site.
Open rhinoplasty is performed through an external entrance. The incisions pass through the skin of the nasal passages (called columella) and the thin septum between the wings. A longer and, more importantly, permanent incision allows the surgeon to transfer the skin to the bridge of the nose and get an excellent view of the internal anatomical structures (cartilage, bones) that need to be replaced. After correction, small scars remain at the site of the incisions, and as a result they become almost invisible.
Open plastic: features of the method
According to patients, the main disadvantage of open rhinoplasty is the presence of small scars on the skin of the caudal parts of the nose after correction. Postoperative scars are unlikely to be noticeable, and although it is almost impossible to see them after the rehabilitation period is over, many are confused by their presence. This forces patients to seek out specialists who are willing to make adjustments in a closed manner.
For a plastic surgeon, minimizing or eliminating visible scars is no less important, but for a specialist, other features of the technique come to the fore. Open rhinoplasty is associated with damage to the columella, and this is a significant disadvantage not only in terms of scarring, but also in terms of the long-term aesthetic consequences of surgery.
Why is it important to damage the thin skin bridge between the nasal passages? Columella performs important functions. Inside this anatomical formation are blood vessels - arteries, veins - through which nutrients and oxygen enter the distal end of the nose.
Columella arteries are responsible for tissue trophism, and therefore their safety during plastic surgery affects the dynamics of the recovery period. Columellar veins drain venous blood. Their damage is fraught with deterioration of drainage function and an increase in obstruction, which manifests itself with more severe and persistent swelling of the nasal tip after surgery.
The second aspect is related to the auxiliary function of the columella. This is a kind of "support" that keeps the tip in the correct anatomical position. During open surgery, the support function of the columella may be impaired, which can theoretically (and in practice) lead to an aesthetic complication in the form of long- or medium-term flexion of the tip.
Thus, the main disadvantages of open rhinoplasty are:
- Columiary arteries are damaged, which worsens the dynamics of the recovery period, increasing the severity and duration of edema.
- Columella's supportive function deteriorates, resulting in the risk of an aesthetic complication in the form of flexion of the tip.
- Small scars remain on the skin.
There are clear methods and advantages. The main thing is that a continuous and elongated (relatively elongated) incision allows the surgeon to fully open the surgical site and gain good access to the anatomical formations of the nasal skeleton. When complex manipulations on deep elements are required, a good view of the surgical site is crucial. It is very important during secondary or reconstructive correction after a severe fracture, and therefore such interventions are almost always performed openly.
Closed method: features
Are the advantages and disadvantages of closed rhinoplasty a mirror image of the pros and cons we discussed in the previous section? To some extent, this is the case.
Closed rhinoplasty is accompanied by less trauma to the soft tissues. Columella is not dissected, respectively, and does not damage the arteries and veins that carry nutrients and oxygen, and the arteries where tissue fluid is drained from the ends. As a result, recovery after closed rhinoplasty is usually faster. Edema is less pronounced and passes more quickly.
The risk of aesthetic complications in the form of bending the tip is less. There are no visible scars on the skin, which is a crucial argument in favor of closed rhinoplasty for many patients.
Advantages of the closed method:
- Less bleeding, less noticeable damage to the soft tissues of the caudal parts of the nose.
- The arteries and veins responsible for the high blood supply are not damaged.
- Columella's support function is preserved, there is no risk of falling off the tip after adjustment.
- There are no scars on the skin.
- Recovery is faster after surgery. 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 closed surgery, but unfortunately not all. Revision plastic surgery requires a complete view of the surgical site, and therefore open rhinoplasty is most commonly used in repeat surgeries.
Type plastic, despite its apparent simplicity, often requires the use of an open incision. If large grafts need to be installed to model the shape and correct the defect, the surgeon must use external incisions, as sometimes it is not possible to install large implants with an internal approach.
The choice between open and closed rhinoplasty is largely determined by the nature of the problem the patient presents to the plastic surgeon. If it is possible to achieve a high aesthetic result only with external incisions, the surgeon chooses the open method. If the correction can be performed through both external and internal incisions, a closed operation is preferred.
You will receive detailed information about the features, disadvantages and advantages of closed and open rhinoplasty in an individual consultation with a plastic surgeon.