Very often, the first question a prospective rhinoplasty patient will ask me is “where are the cuts?” I always appreciate this question, because it is a good segue to discussing the procedural technique, but I believe that patients are also concerned with having scars. In all cases, my answer is: It depends.
There are two approaches to nasal surgery, referred to as the “closed” and “open” techniques. With “closed” rhinoplasties, the skin is not cut and there are no visible scars; all incisions are inside the nostrils. Through these “intranasal” incisions, the surgeon can sculpt the cartilage and bone of the nose, place pieces of cartilage to increase support, and improve breathing. The closed technique has been popular throughout the age of modern rhinoplasty, and is an excellent technique for most first-time surgeries, straight forward revision procedures, and surgeries to improve breathing. The challenge with the closed technique, however, is that the cartilage and bone being sculpted sometimes cannot be seen by the surgeon. He or she needs a complete understanding of nasal anatomy and very confident and steady hands.
The “open” technique is relatively new, and uses an incision across the skin between the nostrils. Then, the skin of the nose is partially lifted off the underlying structural foundation, and the foundation (cartilage and bone) is shaped. So, this technique does leave a skin scar, albeit a small and barely perceptible one. Another challenge is the wider area of surgery – lifting the skin leads to more scarring under the skin, and the way this scar tissue heals is somewhat unpredictable. But, the open technique has the advantage of letting the surgeon see all cartilage, so sculpting is exact. This feature makes the open technique good for difficult revisions, and major airway changes. The open technique is also easy to learn, since everything is visible, so many younger surgeons these days use the open technique.
No single approach is right for all patients, and the technique that may be best for you is decided based on the advantages and disadvantages summarized above. Still, some surgeons today use exclusively either the closed or open technique for all patients. Often, they are not sufficiently experienced in both. Here at the Aesthetic Facial Plastic Surgery Medical Clinic, both approaches are available. This is important, because the approach “sets the tone” for the entire procedure, and choosing the best for you will lead to the best possible outcome. If you have questions about rhinoplasty, please come talk to us – we’ll then answer the question “to open or not to open?”.
