Whether for cosmetic or medical reasons, when a person chooses to undergo rhinoplasty surgery, their doctor will have options as to how they will perform the procedure. Everyone who has any kind of surgery hopes that the scarring left behind will be minimal or can be easily hidden. There is also a hope that the procedure will produce finished results that the patient is happy with. Fortunately, rhinoplasty usually leaves minimal or no scarring and can make a dramatic difference in the appearance of your face. When discussing rhinoplasty surgery, there are two main techniques that are most commonly employed – open and closed.
Choosing Open vs. Closed Rhinoplasty
Patients often ask their doctor what technique will be used during their surgery. In most cases, the problem to be corrected, and the severity of that problem will dictate which type of procedure will be performed. Each procedure can produce good results as long as you choose a qualified doctor and discuss your expectations with him beforehand.
Open rhinoplasty is known medically as external rhinoplasty while the closed procedure is referred to as endonasal rhinoplasty. Central to the open rhinoplasty is an incision to the columella, which is the external piece of skin and tissue that separates the nostrils. Although this is an external incision, very fine stitches are used in closing in order to minimize or eliminate any scarring.
Following the columellar incision, the remaining cuts are made on interior parts of the nose, hiding them from view and leaving no outward scarring. Due to the first incision of the columella, the doctor performing an open rhinoplasty has the advantage of actually seeing the anatomy of the nose internally as it appears prior to the surgery and can discern the causes of any asymmetry within the nose.
Open rhinoplasty also permits the doctor to easily place any necessary cartilage grafts or spreaders to correct aesthetic or medical problems. On the downside, due to the additional incision and stitching, and sometimes the extent of the problem being corrected necessitating an open procedure, there is a chance the patient will experience increased swelling and loss of feeling at the tip of the nose.
Closed rhinoplasty is a bit of a misnomer, as, in the case of any surgery, the procedure cannot be performed unless the patient is “opened” to some extent. While rhinoplasty is obviously not open heart surgery, it still requires incisions and the opening of the skin to address the problem being treated. This is why doctors prefer to call this type of procedure an endonasal rhinoplasty rather than speaking of “open” and “closed”. In most cases, the doctor has the ability to see all parts of the nasal anatomy and to make the corrections and alterations necessary via the closed technique.
There exists a subset of closed rhinoplasty procedures that include the delivery and non-delivery methods. Delivery refers to the ability of the doctor to deliver or move the tip cartilage through the nostrils to allow for a more clear view of the internal nasal structure. Typically only a very skilled surgeon will use the non-delivery method to make changes to the nasal structure with a minimal amount of disruption, trauma, and scarring to the area.
In the long run, unless the patient’s specific problem requires the use of the open technique, it is not important which technique the doctor uses. What is more important is that the doctor is qualified, and that the patient is comfortable with the doctor performing their surgery. To make sure you are comfortable, choose a board certified plastic surgeon and discuss his credentials and past experience, as well as your expectations for the rhinoplasty, before undergoing the procedure.