Nasal surgery using closed or open rhinoplasty access. The discussion about which is the best option for rhinoplasty is not only going on in the nasal surgery forum, but also continues in the plastic surgeon community. Some experts believe that most aesthetic and/or functional problems can be better addressed with the help of closed rhinoplasty; others hold a different view and operate on patients more often with an open approach.
Which method is better - open or closed rhinoplasty? The proposed publication discusses the main features of each rhinoplasty modality, the main advantages and disadvantages of the method.
General information
The main difference between the methods considered is the positioning of the surgical approach. Closed rhinoplasty is performed through an internal channel. The incision is made through the mucous membrane of the nasal passage, and the skin of the wings and columella is not damaged. With this option, the plastic surgeon can actually access the deep anatomy of the left and right halves of the nasal bone twice independently, which somewhat reduces the visibility of the surgical field.
Open rhinoplasty is performed through an external visit. The incision is made through the skin of the nasal passage (called the columella) and the thin septum between the wings. The longer, and most importantly, continuous incision allows the plastic surgeon to move the skin at the tip to the bridge of the nose and gain an excellent view of the internal anatomy (cartilage, bone) that needs to be altered. After correction, small scars remain at the incision and eventually become almost invisible.
Open Plastics: Characteristics of the Approach
According to patients, the main disadvantage of open rhinoplasty is the small scars left on the skin at the end of the nose after correction. Although post-operative scars are barely noticeable and nearly impossible to see after the recovery period, many people are confused about their existence. This forces patients to seek specialists who are prepared to perform corrections in a closed manner.
It is also important for plastic surgeons to have minimal or no visible scarring on the skin, but other features of the technique are most important to specialists. Open rhinoplasty is associated with columellar injury, 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 it important to damage the thin-skinned bridge between the nasal passages? Small columns perform important functions. Inside this anatomy are blood vessels - arteries, veins - through which nutrients and oxygen travel to the tip of the nose.
The columellar arteries are responsible for tissue nutrition, so their safety during plastic surgery affects the dynamics of the recovery period. The columellar vein drains venous blood. Their damage is fraught with deterioration of drainage function and increased congestion, which is manifested by an increase in the severity and persistence of post-operative swelling of the nasal tip.
The second aspect has to do with the fact that the columns perform support functions. This is a "support" that keeps the tip in the correct anatomical position. During open surgery, the support function of the columella may be compromised, which in theory (and in practice) can lead to aesthetic complications in the form of tip drooping in the long or medium term.
Therefore, the main disadvantages of open rhinoplasty are as follows:
- The columellar arteries are damaged, which worsens the dynamics of the recovery period, increasing the severity and duration of edema.
- The support function of the columella deteriorates, leading to the risk of aesthetic complications in the form of tip sagging.
- Small scars remain on the skin.
There is an open approach and advantages. The key is that the continuous and extended (relatively extended) incision allows the surgeon to fully open the surgical field and gain good access to the nasal bone anatomy. A good view of the surgical field plays a decisive role when complex manipulations of deep elements are required. Important during secondary or reconstructive corrections following severe fractures, such interventions are almost always performed in an open fashion.
Closure: Features
Are the pros and cons of closed rhinoplasty a mirror image of the pros and cons we discussed in the previous section? To a certain extent, it does.
Closed rhinoplasty is less traumatic to the soft tissue. The columella were not dissected separately, and the veins and arteries that carry nutrients and oxygen and drain tissue fluid from the tip were not damaged. Therefore, recovery is usually quicker after closed rhinoplasty. Edema is less noticeable and subsides faster.
The risk of aesthetic complications in the form of tip drooping is much lower. The absence of visible scarring on the skin became the decisive argument in favor of closed rhinoplasty for many patients.
Advantages of closed methods:
- There is less bleeding and less damage to the soft tissue at the tail of the nose.
- The arteries and veins that supply blood to the tip were not damaged.
- The support function of the columella is preserved and there is no risk of the tip falling off after correction.
- There are no scars on the skin.
- Recovery is faster after surgery. Edema is less pronounced and passage is faster.
The disadvantage of closed methods is their limited capabilities. Yes, many aesthetic problems can be resolved with closed surgery, but unfortunately, not all. Revision surgery requires a comprehensive understanding of the surgical field, so in repeat surgery, open rhinoplasty is most often used.
Tipplasty, despite its apparent simplicity, often requires the use of an open incision. If a large implant needs to be installed to simulate the shape and correct the defect, the surgeon must use an external incision, as it is sometimes not possible to install a large implant through the internal method.
The choice between open and closed rhinoplasty largely depends on the specifics of the problem that the patient turns to the plastic surgeon. If a high degree of esthetics can only be achieved through an external incision, the surgeon may opt for the open approach. Closed surgery is preferred if correction is possible through both external and internal incisions.
In an individual consultation with a plastic surgeon, you will receive detailed information on the features, disadvantages and advantages of closed and open rhinoplasty.