Nasal surgery operations are performed using the closed or open rhinoplasty access. Discussions about what is the best option for rhinoplasty continue not only in rhino surgery forums, but also in the plastic surgeon community. Some experts believe that most problems of an aesthetic and / or functional nature are best resolved with the help of closed rhinoplasty; others have a different point of view and more often operate 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 fundamental difference between the methods considered is the localization of the surgical approach. Closed rhinoplasty is performed through an internal access. 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, in fact, obtains 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 via external access. The incisions pass through the skin of the thin septum between the nasal passages (called columella) and the wings. A longer and, above all, continuous incision allows the plastic surgeon to move the skin of the tip up to the bridge of the nose and to have an excellent view of the internal anatomical structures (cartilage, bones) that need to be modified. After correction, small scars remain at the incision site, which eventually become almost invisible.
Open plastic: features 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 barely noticeable and after the completion of the rehabilitation period it is almost impossible to see them, many are confused by the very fact of their presence. This forces patients to seek out specialists who are ready to make a correction in a closed manner.
For a plastic surgeon, even the minimization or complete absence of visible scars on the skin is not of little importance, but for a specialist other features of the technique emerge. Open rhinoplasty is associated with damage to the columella, and this is a very significant drawback, not only in terms of scarring, but also in terms of the long-term aesthetic consequences of the surgery.
Why is damage to the thin skin bridge 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.
The 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 deterioration of the 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 performs a support function. It is a kind of "support" that keeps the tip in the correct anatomical position. During an open operation, the supportive function of the columella can be impaired, which in theory (and in practice) in the long or medium term can lead to an aesthetic complication in the form of a drooping toe.
Hence, the main 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 load-bearing function of the columella deteriorates, with the consequent risk of an aesthetic complication in the form of a drooping tip.
- Small scars remain on the skin.
There is an open method and advantages. The key is that a continuous and extensive (relatively large) 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 way.
Closed method: characteristics
Are the advantages and disadvantages of closed rhinoplasty a mirror image of the pros and cons we talked about in the previous section? To some extent it is.
Closed rhinoplasty is accompanied by less trauma to the soft tissues. The columella is not dissected, respectively the veins and arteries that carry nutrients and oxygen and through which the tissue fluid is drained from the tip are not damaged. Consequently, after closed rhinoplasty, recovery is generally faster. Edema is less pronounced and passes faster.
The risk of cosmetic complications in the form of a falling toe is much lower. There are no visible scars 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 support function of the columella is preserved, there is no risk of dropping the tip 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 capabilities. Yes, many cosmetic problems can be solved with a closed operation, but, unfortunately, not all of them. Revision plastics require a complete view of the surgical field, and therefore, in repeated operations, open rhinoplasty is often used.
Tip plasty, despite its apparent simplicity, often also requires the use of an open incision. If large grafts need to be installed to shape the shape and correct a defect, the surgeon must 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 specifics of the problem with which the patient referred to the plastic surgeon. If only with external incisions it is possible to obtain a high aesthetic result, the surgeon chooses the open method. If the correction can be performed through both external and internal incisions, a closed operation is preferable.
You will receive detailed information on the features, disadvantages and advantages of closed and open rhinoplasty during an individual consultation with a plastic surgeon.