Nasal surgery operations are performed using closed or open rhinoplasty access. Discussions about which rhinoplasty option is best continue not only in the rhinosurgery forums, but also in the plastic surgeon community. Some experts believe that most of the problems of an aesthetic and / or functional nature are better solved with the help of closed rhinoplasty; others hold a different point of view and more often operate on patients with an open method.
Which method is better - open or closed rhinoplasty? The proposed publication discusses the key features of each variant of rhinoplasty access, the main advantages of the methods and their disadvantages.
general information
The key difference between the considered methods 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, gets two independent access 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 through external access. The incisions pass through the skin of the thin septum between the nasal passages (called the columella) and the wings. A longer and, most importantly, continuous incision allows the plastic surgeon to move the skin of the tip to the bridge of the nose and get an excellent view of the internal anatomical structures (cartilage, bones) that need to be changed. After correction, small scars remain at the site of the incisions, 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 hardly 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 look for specialists who are ready to carry out a correction in a closed way.
For a plastic surgeon, the minimization or complete absence of visible scars on the skin is also of no small importance, but other features of the technique come to the fore for a specialist. Open rhinoplasty is associated with damage to the columella, and this is a very significant disadvantage, not only in terms of scarring, but also in terms of long-term aesthetic consequences of surgical intervention.
Why is damage to the thin skin bridge between the nasal passages important? Columella performs important functions. Inside this anatomical formation are blood vessels - arteries, veins - through which nutrients and oxygen enter the distal tip of the nose.
Columellar arteries are responsible for tissue trophism, and therefore their safety during plastic surgery affects the dynamics of the recovery period. Columellar veins drain venous blood. Their damage is fraught with a deterioration in the drainage function and an increase in congestion, which is manifested by a greater 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 supporting function. This is a kind of "support" that holds the tip in the correct anatomical position. During an open operation, the supporting 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 tip drooping.
So, the key disadvantages of open rhinoplasty are as follows:
- Columellar arteries are damaged, which worsens the dynamics of the recovery period, increases the severity and duration of edema.
- The supporting function of the columella deteriorates, resulting in the risk of an aesthetic complication in the form of tip drooping.
- Small scars remain on the skin.
There is an open method and advantages. The key is that a continuous and extended (relatively extended) 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: features
Are the advantages and disadvantages of closed rhinoplasty a mirror image of the pros and cons we talked about in the previous section? To a certain extent, it is.
Closed rhinoplasty is accompanied by less trauma to soft tissues. The columella is not dissected, respectively, the veins and arteries that bring nutrients and oxygen, and through which tissue fluid is drained from the tip, are not damaged. As a result, after closed rhinoplasty, recovery is usually faster. The edema is less pronounced, and it passes faster.
The risk of aesthetic complication in the form of tip drooping 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 supporting 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 aesthetic problems can be solved with a closed operation, but, unfortunately, not all. Revision plasty requires a full view of the surgical field, and therefore, in repeated operations, open rhinoplasty is most often used.
Tip plasty, despite its apparent simplicity, also often requires the use of an open incision. If it is necessary to install large grafts to model the shape and correct a defect, the surgeon has to use external incisions, since 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 turned to the plastic surgeon. If a high aesthetic result can only be obtained with external incisions, 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 about the features, disadvantages and advantages of closed and open rhinoplasty at an individual consultation with a plastic surgeon.