Nasal surgery is performed through closed or open access for rhinoplasty. Discussions about which rhinoplasty option is best continue not only in the rhinosurgery forums, but also in the community of plastic surgeons. Some experts believe that most of the aesthetic and / or functional problems are better solved with the help of closed rhinoplasty; others have a different point of view and operate on patients with an open method more often.
Which method is better - open or closed rhinoplasty? The proposed publication discusses the main features of each option for access to rhinoplasty, the main advantages of the methods and their disadvantages.
General information
The main difference between the considered methods is the localization of the surgical approach. Closed rhinoplasty is performed through 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 actually gets two independent accesses 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 through external access. The incisions pass through the skin of the thin barrier between the nasal passages (called columella) and the wings. A longer and most important continuous incision allows the plastic surgeon to move the skin from the tip to the nose and get an excellent view of the internal anatomical structures (cartilage, bones) that need to be replaced. After correction of the incision site, small scars remain, which eventually become almost invisible.
Open plastic: characteristics of the method
According to the 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 the postoperative scars are almost invisible and it is almost impossible to see them after the rehabilitation period, many are confused by the very fact of their presence. This forces patients to look for specialists who are ready to make corrections in a closed way.
For the plastic surgeon, the minimization or complete absence of visible scars on the skin is also important, 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 scars, but also in terms of 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 there are blood vessels - arteries, veins - through which nutrients and oxygen enter the distal tip of the nose.
Columelar 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 deterioration of drainage function and increased congestion, which is manifested by greater severity and persistence of swelling at the tip of the nose after surgery.
The second aspect is related to the fact that columella performs a supporting function. This is a kind of "support" that keeps the tip in the correct anatomical position. In open surgery, 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 sagging of the tip.
Thus, the main disadvantages of open rhinoplasty are as follows:
- The 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, leading to a risk of an aesthetic complication in the form of sagging of the tip.
- Small scars remain on the skin.
There is an open method and advantages. The key is that a continuous and extended (relatively elongated) 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, good visibility of the surgical field plays a crucial role. It is very important during secondary or reconstructive correction after a severe fracture and therefore such interventions are almost always performed openly.
Closed method: characteristics
Are the advantages and disadvantages of closed rhinoplasty a mirror image of the pros and cons we talked about in the previous section? To some extent this is the case.
Closed rhinoplasty is accompanied by less soft tissue injury. The columella is not dissected, so the veins and arteries that supply nutrients and oxygen and through which the tissue fluid drains from the tip are not damaged. As a result, after closed rhinoplasty, recovery is usually faster. The swelling is less pronounced and passes faster.
The risk of an aesthetic complication in the form of sagging at the top 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 severe soft tissue damage to 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. The swelling is less pronounced and passes faster.
The disadvantage of the closed method is its limited capabilities. Yes, many aesthetic problems can be solved with closed surgery, but, unfortunately, not all. Revision plastics require a complete view of the surgical field and therefore open rhinoplasty is most often used in multiple surgeries.
Plastic on top, despite its apparent simplicity, also often requires the use of an open incision. If it is necessary to install large grafts to shape the shape and correct the defect, the surgeon must use external incisions, as 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 be obtained only with external incisions, the surgeon chooses the open method. If the correction can be made through both external and internal incisions, closed surgery is preferred.
Detailed information about the features, disadvantages and advantages of closed and open rhinoplasty will be given in an individual consultation with a plastic surgeon.