Rhinoplasty, open or closed?
Maybe one of the dilemmas before facing a rhinoplasty is; which procedure should I choose? These two procedures are known as open and closed. These two terms, are simply referred to the two different nose approaches. That’s the access method to move away the nasal tissue and ease the exposure of the nasal bone structure. Theoretically, every external change is linked with an internal change in the nasal bones, so, the surgery procedure has a direct implication to make a proper operation and consequently, a direct implication in the quality of the rhinoplasty.
When a closed rhinoplasty is done, every incision are done inside the nostrils. Although parallel incisions include almost the half of the nasal lining, no incision can be seen externally and will not left any scars on it. However, as the incisions made in the left and right nostril remain disconnected, nasal issue reposition is complex and the whole operation must be leaded through little surgery incisions with reduced visibility. As the access to the nose structure requires a strong skin stretching, nasal gristle deformation is unavoidable. Although leaving a scar is to be avoid, there are several difficulties and limitations related to the limited access to the operation area. So, closed rhinoplasty just refers to the lack of visibility when the operation is done.
What differences closed rhinoplasty from open rhinoplasty, is that in the open one a little cut is done through the columella to connect the cuts done on the left and right nostrils. Thanks to this little cut (just 4-5 mm), we can fold the skin up (like in a convertible car) and obtain a perfect view from the lower nasal bone. Besides, we have direct access to almost the whole nose bone structure, thanks to this, nose gristle is not strained and you can judge every element in a more accurate way.
Although several aspects of a unattractive nose can be corrected using a closed rhinoplasty (avoiding the cut on the columella, however, in my opinion, I think that a little scar is overcome by the benefits of an open rhinoplasty). While some surgeons are faithful to the closed rhinoplasty, particularly in those patients with a straight nasal anatomy, we must bear in mind that the development of the open rhinoplasty has revolutionized the treatment related with complex deformities as crooked noses or cleft lips. In fact, many experts consider open rhinoplasties like the only procedure to choose with this kind of deformities.
For these reasons, open rhinoplasty is the one preferred by lots of surgeons, especially in the first operations, because it improves the accuracy of the diagnosis and eases the rebuilding process of deformed noses. However, technical requirements are complex and needs good skills and experience to be done in a proper way.