Nasal surgery operations are performed through a closed or open rhinoplasty approach. Discussions about which is the best rhinoplasty option continue not only in rhino surgery forums, but also in the plastic surgeon community. Some experts believe that most cosmetic and/or functional problems are best resolved with the help of a closed rhinoplasty; others have a different point of view and more often operate on patients with an open method.
Which method is better, open or closed rhinoplasty? The proposed publication discusses the key features of each variant of access to rhinoplasty, the main advantages of the methods and their disadvantages.
General information
The key difference between the methods considered is the location of the surgical approach. Closed rhinoplasty is performed through an internal access. The incisions go through the mucous membrane of the nostrils, the skin of the wings and the columella are not damaged. With this option, the plastic surgeon, in fact, gets two independent accesses to the deep anatomical formations of the left and right half of the nasal skeleton, which somewhat worsens the visibility of the surgical field.
Open rhinoplasty is performed through an external access. The incisions go through the skin of the thin septum between the nostrils (called the columella) and the alae. A longer and more importantly continuous incision allows the plastic surgeon to move the skin from the tip to the bridge of the nose and get an excellent view of the internal anatomical structures (cartilage, bones) that need to be changed. After the correction, small scars remain at the site of the incisions, which eventually become almost invisible.
Open plastic: characteristics of the method.
According to patients, the main disadvantage of open rhinoplasty is that after correction, small scars remain on the skin of the caudal parts of the nose. Although postoperative scars are hardly noticeable, and after completing the rehabilitation period it is almost impossible to see them, many are confused by the mere fact of their presence. This forces patients to seek specialists who are prepared to perform a correction in a closed manner.
For a plastic surgeon, the minimization or total absence of visible scars on the skin is also of no small importance, but other characteristics of the technique become important for a specialist. Open rhinoplasty is associated with damage to the columella, and this is a very significant disadvantage, not only in terms of healing, but also in terms of the long-term cosmetic consequences of the surgical intervention.
Why is it important to damage the thin bridge of skin between the nostrils? The columella performs important functions. Within this anatomical formation there 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. Its damage is fraught with impaired drainage function and increased congestion, which is manifested by increased severity and persistence of swelling of the tip of the nose after surgery.
The second aspect is related to the fact that the columella fulfills a supporting function. This is a kind of "support" that keeps the tip in the correct anatomical position. During an open operation, the supporting function of the columella can be compromised, which in theory (and in practice) in the long or medium term can lead to an aesthetic complication in the form of tip drop.
So, the key disadvantages of open rhinoplasty are as follows:
- The columellar arteries are damaged, which worsens the dynamics of the recovery period, increases the severity and duration of edema.
- The supporting function of the columella is impaired, with the risk of an aesthetic complication in the form of tip drop.
- Small scars remain on the skin.
There is an open method and advantages. The key is that an extended (relatively extended) continuous 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 on deep elements are required, a good view of the surgical field plays a decisive role. It is very important during secondary or reconstructive correction after a severe fracture, and therefore such interventions are almost always performed in an open manner.
Closed method: characteristics
Are the advantages and disadvantages of closed rhinoplasty a reflection of the pros and cons that we discussed in the previous section? To some extent, it is.
Closed rhinoplasty is accompanied by less soft tissue trauma. The columella is not dissected, respectively, the veins and arteries that bring nutrients and oxygen, and through which tissue fluid drains from the tip, are not damaged. As a result, after a closed rhinoplasty, recovery is usually quicker. Edema is less pronounced and passes faster.
The risk of aesthetic complication in the form of tip drop is much lower. There are no visible scars left on the skin, which for many patients becomes a decisive argument in favor of closed rhinoplasty.
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 supporting function of the columella is preserved, there is no risk of the tip falling off after correction.
- There are no scars on the skin.
- Recovery after surgery is faster. Edema is less pronounced and passes faster.
The disadvantage of the closed method is its limited capacity. Yes, many cosmetic problems can be fixed with a closed operation, but unfortunately not all. Revision plasty requires a complete view of the surgical field, and therefore, in repeated operations, open rhinoplasty is most often used.
Tip plasty, despite its apparent simplicity, also often requires the use of an open incision. If large grafts need to be installed to shape and correct a defect, the surgeon has to use external incisions, as 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 details of the problem with which the patient came to the plastic surgeon. If a high aesthetic result can only be obtained with external incisions, the surgeon chooses the open method. If the correction can be done through external and internal incisions, a closed operation is preferable.
You will receive detailed information about the characteristics, disadvantages and advantages of closed and open rhinoplasty in an individual consultation with a plastic surgeon.