Open vs Closed Rhinoplasty
Nose surgery is performed in two ways, open and closed, although in past, the closed method was used more, but today, after acquiring new techniques, choosing open method is a priority. In general, the difference between closed and open rhinoplasty is in the type of access to bone and nose cartilage.
In open rhinoplasty, the surgeon usually cuts the sides of the nostrils, the lower area of the bridge(columella), and inside the nostrils to lift the nasal skin and reshape the nose. But, in closed rhinoplasty, the surgeon usually does not lift the nose skin and only makes two incisions in the inner area of the nostrils and can reshape limited changes to the nose.
In closed rhinoplasty, all the necessary incisions are made inside nose, and then the skin is separated from its cartilaginous structure very narrowly and held high by special tools so that surgeon can do his job. But for this reason, the doctor’s binocular vision will be limited in closed method.
If the nose cartilage needs to be repaired, it will be removed through the incisions made inside nose after being released from skin.
Benefits of Closed nasal surgery
Shorter surgical time
In closed method, less anesthesia is needed to perform rhinoplasty, this factor is considered important for some clients. Also, due to the smaller incision in this method, the surgery time is shorter than open method.
Due to the fact that in closed method, no external incisions are made, so no wound is left on skin, incisions of this method are made in nose inner areas.
More blood circulation
A very important point that we should pay attention to in closed method is the amount of blood circulation in skin, since in closed nasal surgery there is no incision on columella, so the blood circulation in this area of skin does not stop.
In closed method, because the skin’s natural drainage channels are not touched during surgery, swelling is reduced and nose improves sooner, and as a result, the recovery period is shorter.
Disadvantages of closed Rhinoplasty
- Due to having less vision in this method, the rhinosurgeon must have a very high skill.
- Restrictions on difficult operations such as rhinoplasty, crooked rhinoplasty, etc.
- It is difficult to visualize the nose normally in this way.
- There is a possibility of damage to nose structure.
In open nasal surgery, an incision is made in septum between two nostrils which called columella, after which the surgeon removes skin from nose underlying structure. In this situation, the doctor will simply be familiar with all the anatomy and defects of nose, and access to nose tip is easier.
In addition, correction of asymmetry, placement and fixation of cartilage grafts are better done in this method. Also, secondary (revision) nasal surgery is possible only with open nasal surgery.
Benefits of Open nasal surgery
Surgeon’s better vision
In this method, due to skin separation from nasal skeleton, the nasal surgeon can easily observe nasal defects and eliminate them. Also, asymmetry is less likely to occur in open nasal surgery.
Easier placement of grafts or prostheses
In some cases, it is necessary to strengthen nasal skeleton with cartilage grafts or grafts and prostheses, which is easier in open method.
Difficult surgical procedures:
If nose is crooked, twisted or needs reconstructive surgery; the surgeon’s priority for rhinoplasty will be open procedure. Also, in this method, access to nose tip is easier and if changes are needed in this area, the surgeon can easily see and correct them.
Disadvantages of open nose surgery
- Swelling due to rhinoplasty is more in open method.
- Because open nasal surgery is more invasive, the recovery time after surgery is longer because there is less blood circulation at nose tip.
- Due to the incision on columella, scars remains for several weeks after operation and then disappears over time and is not recognizable.
- In this method, the surgery time is longer.
Is closed or open rhinoplasty better?
The choice of rhinoplasty method depends on the surgeon, number of defects in nose, etc., and it is not possible to say with certainty which method is better than the other.
Given the difference between closed and open rhinoplasty, is there a difference in care after rhinoplasty in these two methods?
No, care tips after open and closed rhinoplasty are no different, and all the care that rhinosurgeons offer to achieve ideal result is same for both methods.
source : dr-besharatizadeh.ir