Differences Between Open and Closed Rhinoplasty

Rhinoplasty techniques, open and closed, show some differences. Open technique surgeries allow for a more detailed view of the nasal structure. Thus, the surgeon can better address both aesthetic and functional problems. The closed technique, on the other hand, is less invasive and generally has a shorter recovery time. Both methods offer different advantages depending on the surgeon’s skill and the patient’s nasal structure.

Comparison of Open and Closed Rhinoplasty Techniques

Open and closed rhinoplasty techniques differ in terms of surgical approaches. In the open technique, a small incision is made between the nostrils. This allows the surgeon to see the nasal structure more clearly. This is a significant advantage, especially when complex structures need to be corrected. In the closed technique, the incisions remain inside the nostrils. No external scars are visible with this technique.

Open technique:

• Expands the surgeon’s field of view.
• Ideal for complex corrections.

Closed technique:

• Less invasive.
• Recovery time is generally shorter.

Both techniques offer various advantages, and the choice is usually made based on the patient’s needs and the surgeon’s preferences. Open technique interventions may be more suitable in cases requiring detailed corrections. The closed technique, on the other hand, may be preferred for a quicker recovery process. Both methods aim to preserve and improve nasal function.

Justifications for Application

Open and closed rhinoplasty methods are chosen based on functional and aesthetic needs. Open rhinoplasty provides the opportunity to better observe the nasal structure. This is a significant advantage, especially when complex deformities need to be corrected. This method also facilitates the training process for surgical team members who will receive training.

Closed rhinoplasty, on the other hand, is a less invasive approach and generally offers a faster recovery process. This technique is often preferred for aesthetic interventions because the likelihood of scarring is lower.

Proper evaluation of patient candidates is crucial for both techniques:

Functional Issues:

• Nasal congestion
• Airflow obstructions
• Breathing difficulties

Aesthetic Issues:

• Dorsal hump
• Nasal deviation
• Tip issues

Considerations for Rhinoplasty Operations

Rhinoplasty procedures should be carefully planned considering specific health conditions and past surgical experiences. First, patients with body dysmorphic disorder may be less satisfied after surgical intervention. Early diagnosis of individuals with this disorder is critical to minimize the disappointments they may experience due to unrealistic expectations.

Individuals with obstructive sleep apnea also require special attention. Airway obstructions that occur during sleep can increase risks during and after surgery. These patients should take appropriate precautions before surgery to reduce risks.

Cocaine use can cause severe damage to nasal tissues, which can negatively affect rhinoplasty results. Patients in this condition should have quit this habit before surgery.

The medical history of patients considering rhinoplasty should be meticulously examined. Especially bleeding disorders, active allergic conditions, or chronic sinusitis issues should be considered in the operation planning. Individuals using anticoagulant or antiplatelet drugs may need to temporarily stop these medications.

Closed Rhinoplasty Procedures and Methods

Closed rhinoplasty is performed with incisions made inside the nose. This technique leaves no visible external scars and generally offers a faster recovery process. Limited access to the surgical field requires great confidence in the surgeon’s skills. Additionally, incisions made during the procedure allow for intervention in the nasal structure, and necessary corrections are made meticulously. The procedure is performed under general anesthesia, and infiltration anesthesia provides numbness in the nasal area.

Dorsal Treatment: If necessary, corrections are made to the nasal dorsum.

• This stage is carried out using various methods to correct the shape of the nasal dorsum.
• Care is taken to ensure that the cut areas are smooth and even.

Tip Modifications: The shape and position of the nasal tip can be changed.

• These corrections are made using various grafts and incision techniques.
• The applied methods improve the tip projection and aesthetic appearance.

After surgery, nasal structures are supported, and mucosal incisions are closed with absorbable sutures. The procedure is carefully planned and applied to provide aesthetic and functional improvements.

Details and Applications of Open Rhinoplasty Techniques

Open rhinoplasty requires a detailed technique in plastic surgery. Full access to the nasal anatomy by the surgeon increases the success of the surgery. The procedure requires in-depth understanding and careful application. Each surgical step directly affects the accuracy of the result and patient satisfaction. The fundamental maneuvers performed during open rhinoplasty are detailed below:

Opening the nose:

• A reverse-V incision is made in the mid-columella.
• The incision is converted to marginal incisions with hooks and sharp dissection.
• Upper lateral cartilages are preserved and exposed.

Septoplasty:

• The anterior septal angle is sharply exposed.
• A sub-mucoperichondrial pocket is created for septoplasty.
• Septal cartilage is harvested while preserving sufficient structural support.

Dorsal hump reduction:

• The bony hump is corrected with osteotomes and rasps.
• The cartilaginous dorsum is reduced without damage.

Nasal tip contouring:

• Various suture-based techniques are applied.
• Cartilage perichondrium or softened cartilage grafts are added if necessary.

Alar rim grafts:

• Small onlay grafts are placed along the alar rim.
• Used to prevent alar retraction.

Alar base reduction:

• The width of the nasal base and nostril size are corrected.

Osteotomies:

• Various techniques are applied to narrow the bony dorsum.

Complications Related to Closed Rhinoplasty

Closed rhinoplasty is characterized by surgical procedures performed inside the nose. Limited direct access to the nasal structure can present some challenges. Although this method provides aesthetic corrections and functional improvements, it can be associated with various complications.

Hemorrhagic Complications:

• Epistaxis is usually mild and can be controlled with simple interventions.
• Septal hematoma can lead to serious complications and requires early intervention.

Infectious Complications:

• Cellulitis is generally controlled with antibiotic treatment.
• Septal abscesses show serious infection signs and should be treated immediately.

Traumatic Complications:

• L-strut damage can cause septal deformities.
• Intracranial injuries and lacrimal duct damage should be prevented with careful surgical techniques.

Functional Complications:

• Septal perforation can be minimized with careful surgical applications.
• Nasal adhesions require intervention in the postoperative period.

Aesthetic Complications:

• Asymmetry and deformities in the tip area can be reduced with careful planning and application.
• Pollybeak deformity in the dorsal region should be corrected with appropriate treatment methods.

Complications of the Open Rhinoplasty Method

Open rhinoplasty is a frequently preferred method among nasal aesthetic surgeries. However, this technique can cause some specific complications. Firstly, although major complications are quite rare, some situations require attention. Complications usually arise in the postoperative period and can directly affect aesthetic results.

Unique cosmetic complications are listed below:

Tombstone deformity: A noticeable shape forms under the nasal tissue due to the excessive rigidity of the shield graft.
• Rocker deformity: Excessive advancement of lateral osteotomies causes outward pushing of the nasal bone.
• Inverted-V deformity: A connection deficiency between the upper lateral cartilages and nasal bones is observed after hump correction.
• Pollybeak deformity: Overcorrection of the bony dorsum and inadequate correction of the cartilaginous dorsum result in fullness in the nasal tip area.
• Ski slope deformity: Excessive reduction of the hump results in an overly sloped nasal profile.
• Saddle nose deformity: Insufficient septal support creates a collapse in the middle section.
• Nasal bossae: Protrusions form due to cartilage asymmetry.
• Open roof deformity: Incomplete osteotomies create separation in the nasal bone.

Frequently Asked Questions

How do the results differ between open and closed rhinoplasty?

The results obtained from open and closed rhinoplasty techniques differ. In open rhinoplasty, the incision is made over the columella, allowing the surgeon to intervene more clearly in the nasal structure. This is an advantage, especially in correcting complex nasal issues. However, this technique may leave a small scar.

In closed rhinoplasty, the incisions remain inside the nose, so no external scar is visible. This method is ideal for less complex cases and has a faster recovery period. However, due to the limited visibility during surgery, making very detailed corrections is more challenging.

What is the difference in recovery between open and closed rhinoplasty?

The recovery process differs between open and closed rhinoplasty. The recovery period is usually longer due to the external incisions made in open rhinoplasty. Patients generally experience increased swelling and bruising in the first weeks after surgery. This is due to the surgical intervention spreading over a broader area.

On the other hand, closed rhinoplasty has a faster recovery process due to the limited internal incisions. In this method, bruising and swelling may be less, and patients can return to their normal activities more quickly.

Does skin color affect whether open or closed rhinoplasty is performed?

No, skin color does not affect the choice between open or closed rhinoplasty. Surgical preferences and specific surgical goals are the determining factors in this decision. Skin color is not seen as a factor influencing the surgical method. Open and closed rhinoplasty applications can be successfully performed for all skin types. Especially in open rhinoplasty, the small scar that forms heals over time, becoming indistinct across all skin colors.

The surgeon’s experience and techniques applied play a crucial role in optimizing aesthetic and functional results. Patients’ skin color does not impose any limitations on surgical outcomes. Thus, rhinoplasty surgeries can be safely applied to a broad patient population.

Is closed rhinoplasty more expensive than open surgery?

The cost difference between closed and open rhinoplasty cannot be definitively determined. Generally, the surgeon’s experience and reputation can increase the cost for both methods. Additionally, the geographical location where the surgery is performed can cause price variations. The closed method requires more expertise due to the limited field of view. This may lead some surgeons to charge higher fees for this method.

However, it should be noted that both methods have their internal cost variations. Especially complex cases and those requiring revision can increase the cost for both techniques. Therefore, it cannot be said that closed rhinoplasty is always more expensive; the cost varies depending on many factors.

Is closed rhinoplasty safer than open surgery?

Closed rhinoplasty is suitable for cases requiring minor corrections and is less invasive. Therefore, the recovery process is generally faster. Its less invasive nature can make closed rhinoplasty “safer” in some situations. However, the limited visibility provided to the surgeon by this method may be inadequate in solving some complex conditions.

On the other hand, open rhinoplasty allows the surgeon to see the operating area better. This enables more precise corrections to be made. Open rhinoplasty is preferred when complex conditions and significant structural changes are required. The safety of both methods varies depending on the surgeon’s competence and experience.

Prof. Dr. Murat Topdağ

KBB ( Kulak Burun Boğaz)  Doktoru Prof. Dr. Murat Topdağ, 1978 yılında Malatya’da doğmuştur. Cerrahpaşa Tıp Fakültesi İngilizce Bölümü’nden mezun olduktan sonra, 2004-2009 yılları arasında Kocaeli Üniversitesi Tıp Fakültesi Kulak Burun Boğaz Anabilim Dalı’nda uzmanlık eğitimini tamamlamıştır. 2017’de Acıbadem Altunizade Hastanesi’nde görev yapmaya başlamıştır.. 2022 yılından itibaren İstanbul Kadıköy’de bulunan kendi kliniği MD ENT İstanbul’da da hastalarına hizmet vermektedir.