Nasal surgery is performed with a closed or open approach to rhinoplasty. Discussions about which rhinoplasty option is the best continue not only on the forums on rhinosurgery, but also in the community of plastic surgeons. Some experts believe that most problems of an aesthetic and / or functional nature are better solved with the help of closed rhinoplasty; others have a different view and operate on patients more often with the open method.
Which method is better - open or closed rhinoplasty? The proposed publication discusses the key characteristics of each variant of the rhinoplasty approach, 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 approach. 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 approaches to the deep anatomical formations of the left and right halves of the nasal skeleton, which somewhat impairs the visibility of the surgical field.
Open rhinoplasty is performed with an external approach. Incisions pass through the skin of the thin septum between the nasal passages (called columels) and the wings. 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 a great view of the internal anatomical structures (cartilage, bones) that need to be changed. After the correction, small 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 after the correction, small scars remain on the skin of the caudal parts of the nose. Although postoperative scars are poorly noticeable, and after the end of the rehabilitation period it is almost impossible to see them, many are confused by the mere fact of their presence. This forces patients to seek specialists who are willing to make corrections in a closed manner.
For a plastic surgeon, minimizing or completely eliminating visible scars on the skin is also not of small importance, but other characteristics of the technique come to the fore in a specialist. Open rhinoplasty is associated with columella damage, which is a very significant drawback, not only in terms of scarring, but also in terms of the long-term aesthetic consequences of surgery.
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, so their safety during plastic surgery affects the dynamics of the recovery period. Columellar veins drain venous blood. Their damage is met with deterioration of drainage function and increased congestion, which is manifested by greater severity and persistence of swelling of the tip of the nose after surgery.
Another aspect is related to the fact that columella performs a supporting function. This is a kind of "support" that keeps the top in the correct anatomical position. During open surgery, the support function of the columella can be disturbed, which in theory (and in practice) can lead to an aesthetic complication in the long run or in the medium term in the form of falling off the tip.
Thus, the key disadvantages of open rhinoplasty are the following:
- 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 a risk of aesthetic complications in the form of a relaxed tip.
- Small scars remain on the skin.
There is an open method and advantages. It is crucial that continuous and extended (relatively extended) incisions allow 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 needed, a good overview of the surgical field plays a decisive role. It is very important during secondary or reconstructive correction after a severe fracture, so such interventions are almost always performed in an open manner.
Closed method: characteristics
Are the advantages and disadvantages of closed rhinoplasty a mirror image of the advantages and disadvantages we talked about in the previous section? To some extent it is.
Closed rhinoplasty is accompanied by less soft tissue trauma. The columella is not dissected, ie the veins and arteries that bring nutrients and oxygen and through which the tissue fluid is drained from the top, are not damaged. As a result, after closed rhinoplasty, recovery is usually faster. The edema is less pronounced and passes faster.
The risk of aesthetic complications in the form of a relaxed top is significantly 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 severe soft tissue damage to the caudal parts of the nose.
- The arteries and veins responsible for the flow of blood to the top are not damaged.
- The bearing function of the columella is preserved, there is no danger of the tip falling out after correction.
- There are no scars on the skin.
- Recovery after surgery is faster. The edema is less pronounced and passes faster.
The disadvantage of the closed method is its limited possibilities. Yes, many aesthetic problems can be solved with closed surgery, but, unfortunately, not all. Revision plastics require a complete examination of the surgical field, and therefore open rhinoplasty is most often used in repeated operations.
Plastic tip, despite its apparent simplicity, also often requires the use of an open cut. If it is necessary to install large grafts to model the shape and correct the defect, the surgeon must use external incisions, because sometimes it is not possible to install large implants internally.
The choice between open and closed rhinoplasty is largely determined by the specifics of the problem the patient has consulted with the plastic surgeon. If only external incisions can achieve a high aesthetic result, the surgeon chooses the open method. If correction can be reported through both external and internal incisions, closed surgery is preferred.
Detailed information on the characteristics, disadvantages and advantages of closed and open rhinoplasty can be obtained in an individual consultation with a plastic surgeon.