Open Rhinoplasty vs Closed Rhinoplasty
To change the bone and cartilage architecture of the nose, there are two surgical pathways: “Open Rhinoplasty” and “Closed Rhinoplasty.” Learn the differences between these two types of rhinoplasty methods and how the results differ depending on whether the surgeon chooses open rhinoplasty or closed rhinoplasty.
OPEN VS CLOSED RHINOPLASTY
Closed rhinoplasty is a sophisticated surgical technique that surgeons trained within the last 20 years are typically less skilled in. With the increased popularity of nose cartilage, bone, and other tissue-grafting techniques, open rhinoplasty may be advantageous. Revision rhinoplasty may benefit from open rhinoplasty as well. However, closed rhinoplasties are more advantageous than most straight forward rhinoplasties due to their advanced technique.
When comparing open vs. closed nose job, keep in mind that these are merely surgical approaches. The surgeon’s skill and talent are the most important factors in the operation’s success. Either technique can produce excellent results. Yes, the closed rhinoplasty recovery period may be slightly shorter, and yes, the external open rhinoplasty incision may take weeks or even months to ripen and become nearly invisible, but these are relatively short-term issues. What matters is the end result. When the healing of a primary (first-time) rhinoplasty is 80-90 percent complete after three to four months, the differences between closed and open rhinoplasty become insignificant.
Some surgeons have the ability to perform rhinoplasty using both open and closed rhinoplasty techniques. Each procedure has its own set of benefits and drawbacks. Here are some of the most common ones that patients should be aware of.
OPEN RHINOPLASTY ADVANTAGES AND DISADVANTAGES
- More detailed visualization of the nose’s outer structure, including cartilage and bone.
- Better for teaching other doctors, especially surgeons-in-training, such as residents and fellows.
- The ease with which the various parts can be stitched together.
- The external incision/scar may be visible.
- Because of the increased number of incisions and the elevation of more skin from the bone and cartilage skeleton, there is a possibility of a slightly longer healing time/swelling.
CLOSED RHINOPLASTY PROS AND CONS
- All incisions are invisible. Patients who are concerned about “scarring” prefer this option.
- There are no stitches to remove; they all dissolve on their own.
- Because there are fewer incisions to close, the operating time is slightly reduced.
- Much more difficult to master for surgeons-in-training. To be proficient, a significant case load is required in training.
- Technically, it is more difficult. “Performing a whole surgery through a keyhole,” includes making incisions and sewing them closed.
- Performing the procedure from the inside out. Certain parts of the surgery may entail moving some of the cartilage to the outside of the nose, fixing flaws, and then returning to the problematic tissue. Unquestionably a “wow” factor.
WHAT IS CLOSED RHINOPLASTY?
CLOSED RHINOPLASTY (ENDONASAL, INVISIBLE INCISION)
Closed rhinoplasty, also known as endonasal (inside the nose) rhinoplasty, is a type of rhinoplasty that is performed inside the patient’s nose to correct nasal asymmetry. It describes the surgical technique in which the entire operation, including functional components for breathing as needed, is carried out through internal hidden incisions. These incisions are stitched together with absorbable stitches.
Closed rhinoplasty is conducted totally through incisions on the interior of the nose, and the incisions are closed with absorbable stitches at the end of the procedure. Done through the nostrils.
Patients wanting a “hidden” rhinoplasty treatment frequently choose closed rhinoplasty since it is less intrusive and leaves no visible scarring.
WHAT IS OPEN RHINOPLASTY?
OPEN RHINOPLASTY (EXTERNAL RHINOPLASTY)
The open rhinoplasty technique is utilized to acquire access to the structures beneath the skin that must be changed. It’s called so because there’s usually an exterior, visible (though likely only temporary) incision. These methods of cosmetic reconstructive surgeries are preferred when there is an obvious deformity the patient wants addressed, i.e. a crooked hump. Obvious exterior incision is closed with many layers of stitches that are usually removed within a week. While the incision is obvious at the time, it normally becomes less noticeable as it matures over a number of months.
It involves an incision that runs horizontally through the columella or pillar that separates the two nostrils and links to internal incisions to elevate the skin that covers the nose and reveal the bone and cartilage framework. The raised skin is kept elevated during the process and is eventually returned to its bed, with the horizontal incision closed with stitches that are removed about a week after surgery.
Because it is performed through a small incision on the patient’s columella (columellar incision), open rhinoplasty, also known as external rhinoplasty, allows for greater accuracy by the surgeon.
DIFFERENCES BETWEEN BOTH METHODS:
During the surgery, both open vs closed rhinoplasty aim to improve functionality and, in some cases, the appearance of the nose. Having said that, the procedures themselves are quite different. The main distinction between the two is as follows:
Closed rhinoplasty takes less time to perform. Not much longer, but there is often a slight increase in the time required for open rhinoplasty due to the procedure.
The stitches used to close the incisions in closed rhinoplasty are absorbed over time and are located on the inside of the nose. The visible, outside incision is closed with several layers of stitches during open rhinoplasty. Internal layer stitches disintegrate. However, the outside stitches are usually removed within a week. While the incision is visible at the time, it often becomes less noticeable as it matures over a period of months.
DIFFICULTY OF PROCEDURE
Closed rhinoplasty is much more difficult than open rhinoplasty because the nose surgeon will operate from inside the patient’s nostrils rather than using a small bridging incision as in open rhinoplasty.
VISIBILITY OF AN INCISION (SCARRING)
An external, horizontal incision is made between the two nostrils for open rhinoplasty. The extended incision is carried into the nasal interior, where it becomes less visible. The incision from open rhinoplasty usually fades over time, but it can be visible in some patients. The incision is completely hidden with closed rhinoplasty. Patients who are concerned about “scarring” prefer this option.
The price is unaffected by the technique used. The differences in operating room time are not significant enough to have a significant impact on the surgeon’s fee for either open or closed rhinoplasty.
WHY WOULD A DOCTOR CHOOSE AN OPEN RHINOPLASTY OVER A CLOSED RHINOPLASTY FOR A PATIENT?
If a surgeon is not trained in the closed technique, he or she will use the open rhinoplasty approach. Many surgeons who have been trained in the last 20 years are unable to use the alternative closed technique because their teachers are not using it. With the rise in popularity of cartilage, bone, grafts and other tissue-grafting techniques, open rhinoplasty created some advantages. It could also help in revision rhinoplasty. However, if the surgeon has the necessary technical skill and long experience – both of which are absolutely necessary – open rhinoplasty is less advantageous for most primary, straightforward rhinoplasties that doesn’t require additional changes.
Closed rhinoplasty is a technically demanding plastic surgery procedure unless performed by master nasal surgeons who are also excellent technicians. The burden is having to complete an entire operation “through a keyhole.” Through a small tunnel, “cutting and sewing.” Superior training, “good hands,” and a wealth of experience are required. Some parts of the nose must be able to be “visualized” without being seen. However, a surgeon who is familiar with this technique finds it “routine” and very advantageous because the procedure requires fewer incisions and thus has a lower risk of complications. If minimal changes to the nose calls for it, the surgeon might opt out for this method; i.e. no changes to the nostril. Surgeons who are proficient in closed rhinoplasty can easily perform an open rhinoplasty. However, surgeons who favor open rhinoplasty will find it difficult to switch to the closed technique.
With so many methods and options out there, choosing can be overwhelming… That’s why, at Global Medical Care, we did the footwork for you. During our extensive research, we reviewed over 200 private clinics and hospitals along with their doctors to find the accurate ones suitable for your individual needs. During your initial consultation, your general health data, expectations, and pictures will be sent to 3 different doctors to define the best treatment option aligning with your needs. Our team is at your disposal 24/7, if you have any inquires or if you are willing to schedule a complimentary consultation.
- On 08/03/2022