Nasal surgeries are performed with closed or open rhinoplasty access. Discussions continue not only in the rhinoplasty forums but also in the plastic surgeon community as to which rhinoplasty is the best solution. Some experts believe that most aesthetic and / or functional problems can be better solved with closed rhinoplasty; others take a different view and operate on patients more openly.
Which method is better - open or closed rhinoplasty? The proposed publication discusses the main features of each variant of rhinoplasty access, the main advantages and disadvantages of the methods.
general information
The main difference between the methods studied is the localization of the surgical approach. Closed rhinoplasty is performed through internal access. The incisions pass through the mucous membranes of the nasal passages without damaging the skin of the wings and columella. With this option, the plastic surgeon actually gets two independent accesses to the deep anatomical formations on the left and right sides of the nasal skeleton, which somewhat impairs the visibility of the surgical area.
Open rhinoplasty is performed with external access. The incisions pass through the skin of the thin septum between the nasal passages (columella) and the wings. The longer and, most importantly, continuous incision allows the plastic surgeon to move the skin from the tip of the nose to the saddle of the nose and get an excellent view of the internal anatomical structures (cartilages, bones) that need to be replaced. After correction, tiny scars remain at the site of the incisions, which eventually become almost invisible.
Open plastic: characteristics of the method
According to patients, the main disadvantage of open rhinoplasty is that small scars remain on the skin of the tail of the nose after correction. Although scars after surgery are barely noticeable and almost impossible to see after the rehabilitation period, many are disturbed by the fact that they are present. This forces patients to look for professionals who are willing to make a correction in a closed manner.
The minimization or complete absence of scars visible on the skin is also of little importance to a plastic surgeon, but other features of the technique come to the fore for those skilled in the art. Open rhinoplasty involves damage to the columella, and this is a very significant drawback, not only because of the scarring, but also because of the long-term aesthetic consequences of the surgical procedure.
Why is it important to injure a thin skin bridge between the nasal passages? Columella performs important functions. Within this anatomical formation are blood vessels - arteries, veins - through which nutrients and oxygen reach the distal tip of the nose.
Columellar arteries are responsible for tissue trophism, so their safety during plastic surgery affects the dynamics of the healing period. Columellar veins conduct venous blood. Their damage is accompanied by deterioration in drainage function and increased congestion, manifested by more severe and persistent swelling of the nasal tip after surgery.
The second aspect relates to the fact that the columella performs a supportive function. It is a kind of "support" that keeps the tip in the right anatomical position. In open surgery, the supporting function of the columella can be impaired, which in theory (and in practice) can lead to aesthetic complication in the long or medium term in the form of a fall.
So the main disadvantages of open rhinoplasty are:
- Columellar arteries are damaged, which impairs the dynamics of the recovery period, increasing the severity and duration of edema.
- The supporting function of the columella is impaired, resulting in the risk of developing aesthetic complications in the form of a mountain droop.
- Small scars remain on the skin.
There is an open method and benefits. The point is that continuous and extended (relatively extended) incision allows the surgeon to fully open the surgical space and have 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 is crucial. It is very important during secondary or reconstructive correction after a severe fracture, so such interventions are almost always performed openly.
Closed method: characteristics
Are the advantages and disadvantages of closed rhinoplasty a reflection of the advantages and disadvantages discussed in the previous section? To some extent it is.
Closed rhinoplasty is accompanied by minor trauma to the soft tissues. The columella is not dissected, and the veins and arteries that carry nutrients and oxygen and through which tissue fluid is expelled from the mountain are not damaged. As a result, recovery is usually faster after closed rhinoplasty. The edema is less pronounced and goes away faster.
The risk of aesthetic complications in the form of a mountain droop is much lower. There are no visible scars on the skin, which is a crucial argument for closed rhinoplasty for many patients.
Advantages of the closed method:
- Less bleeding, less pronounced damage to the soft tissues of the caudal part of the nose.
- The arteries and veins responsible for the blood supply to the mountain are not damaged.
- The supporting function of the columella is retained, there is no risk of the peak falling off after correction.
- There are no scars on the skin.
- Recovery is faster after surgery. The edema is less pronounced and goes away faster.
The disadvantage of the closed method is the limited possibilities. Yes, many aesthetic problems can be solved with a closed operation, but unfortunately not all. Revision plastic surgery requires a complete review of the surgical field, so open rhinoplasty is most commonly used for repeated surgeries.
Despite the apparent simplicity of mountain sculpture, it often requires an open incision. If large grafts need to be inserted to model the shape and correct the defect, the surgeon must use external incisions, as sometimes it is not possible to insert large implants with an internal approach.
The choice between open and closed rhinoplasty is largely determined by the specifics of the problem the patient has with having a plastic surgeon. If a high aesthetic result can only be achieved with an external incision, the surgeon will choose the open method. If correction can be performed by both external and internal incision, closed surgery should be preferred.
You will receive detailed information about the characteristics, disadvantages and advantages of closed and open rhinoplasty at an individual consultation with a plastic surgeon.