From anatomical perspective a nose can be described as a construction of bones and cartilages covered by skin. In order to change nose shape plastic surgeon needs to insert a surgical instrument underneath the skin and alter the form and placement of osteo-chondral carcass. That’s how we can describe rhinoplasty.

There are two kinds of rhinoplasty: open and closed.

In an “open” rhinoplasty, a small incision is made in the columella, which is a little column of skin that separates two nostrils. That incision allows the nasal skin to be lifted off of the tip of the nose up to the forehead area so the doctor can work with the open frame. When operation is finished, skin is moved back and secured with a cosmetic suture.

In closed rhinoplasty all incisions are made inside, on the mucous membrane of the nostrils. Doctor uses those incisions to separate skin from osteo-chondral carcass and stretch skin to gain access to cartilages and bones. All of it is done without any disruption to skin layer that helps to eliminate scarring.

One does not need to be an expert to see obvious advantages of the closed method. Post operative period is much shorter and less traumatic for closed rhinoplasty patients as their skin does not need to be reattached. Another issue for open rhinoplasty patients is the cosmetic suture which can be partially visible for the rest of one’s life.

Despite evident drawbacks of an open technique it is backed by the majority of plastic surgeons who insist on this method of rhinoplasty. Patients are usually persuaded that a serious nose job that f.i. involves straightening of nasal septum can’t be accomplished with a closed method. According to open rhinoplasty proponents, small incisions are the limitation of this method since they do not give enough access to all nasal areas. Also opening of osteo-chondral carcass provides doctor with a better way to monitor his progress, when closed surgery makes one do a great deal of guesswork.

These statements, however, are highly debatable. First, it was proven on multiple occasions that any changes that can be performed in open surgery can be replicated in closed way, not even mentioning that closed method does not leave a scar on columella and does not involve skinning of the entire nose. Secondly, there is no more guesswork with closed method than with open one as during the closed operation plastic surgeon can actually see the entire nose, not the bleeding osteo-chondral frame. So it is actually easier to assess and adjust one’s work during the closed surgery.

The choice between these two types is majorly based on surgeon’s educational background i.e. whether this doctor was educated to perform closed or open surgery. So if your surgeon claims to tailor his method to patients’ preferences, please be cautious. Specialists who can do both things are a real rarity. So chances that plastic surgeon who specializes in open surgery will reeducate himself for you are pretty slim. By the way open surgery is wide spread in US, while Europe prefers closed type of procedure.

Posted under: Rhinoplasty