Nasal surgery is performed using closed or open access rhinoplasty. Discussions about the best rhinoplasty options continue not only in rhinoplasty surgery forums, but also in the plastic surgeon community. Some experts believe that most problems of an aesthetic and / or functional nature are better solved with the help of closed rhinoplasty; others hold different points of view and more often treat patients with open methods.
Which method is better - open or closed rhinoplasty? The proposed publication discusses the main features of each variant of access rhinoplasty, the main advantages of the method and its disadvantages.
general information
The main difference between the methods considered is the localization of the surgical approach. Closed rhinoplasty is performed through internal access. The incision passes through the mucous membranes of the nasal passages, the skin of the wings and the columella are not damaged. With this option, the plastic surgeon, in fact, gets two independent accesses to the anatomical formations in the left and right halves of the nasal skeleton, which somewhat worsens the vision of the surgical field.
Open rhinoplasty is performed through external access. The incision passes through the skin of a thin septum between the nasal passages (called columella) and the wings. The longer and, most importantly, continuous incision allows the plastic surgeon to transfer the tip skin to the trunk of the nose and get an excellent view of the internal anatomical structures (cartilage, bone) that need to be altered. After correction, small scars remain at the site of the incision, which eventually become almost invisible.
Open plastics: method characteristics
According to patients, the main disadvantage of open rhinoplasty is that after correction, small scars remain on the skin of the caudal part of the nose. Although postoperative scars are almost invisible, and after the end of the recovery period it is almost impossible to see them, many are confused by the fact of their presence. This forces the patient to find a specialist who is willing to perform the correction in private.
For plastic surgeons, minimizing or the absence of visible scars on the skin is also not important, but other features of this technique are preferred by the specialist. Open rhinoplasty is associated with damage to the columella, and this is a very significant drawback, not only in terms of scarring, but also in terms of the long -term aesthetic consequences of surgical intervention.
Why is damage to the thin skin bridge between the nasal passages important? Columella performs an important function. Within this anatomical formation there are blood vessels - arteries, veins - where nutrients and oxygen enter the distal end of the nose.
Columnar arteries are responsible for tissue trophism, and therefore their safety during plastic surgery affects the dynamics of the recovery period. Columnar veins carry venous blood. Their damage is fraught with deterioration of drainage function and increased congestion, which is indicated by the more severe severity and persistence of swelling of the nasal tip after surgery.
The second aspect is related to the fact that columella perform a support function. This is a type of "support" that holds the tip in the correct anatomical position. During open surgery, the support function of the columella can be impaired, which in theory (and in practice) in the long or medium term can lead to aesthetic complications in the form of drooping ends.
So, the main disadvantages of open rhinoplasty are as follows:
- Columnar arteries are damaged, which worsens the dynamics of the recovery period, increasing the severity and duration of edema.
- The support function of the columella deteriorates, resulting in the risk of aesthetic complications in the form of drooping ends.
- Small scars remain on the skin.
There are open methods and advantages. The key is that continuous and extended (somewhat elongated) incisions allow the surgeon to fully open up the surgical field and gain good access to the anatomical formation of the nasal skeleton. When complex manipulations on deep elements are required, a good view of the surgical field plays a decisive role. It is especially important during secondary or reconstructive correction after a severe fracture, and therefore such interventions are almost always performed in public.
Closed method: feature
Are the advantages and disadvantages of closed rhinoplasty a mirror image of the pros and cons we discussed in the previous section? To some degree, it is.
Closed rhinoplasty is accompanied by less trauma to the soft tissues. Columella are not dissected, respectively, the veins and arteries that carry nutrients and oxygen, and through which tissue fluid is drained from its ends, are not damaged. As a result, after closed rhinoplasty, recovery is usually faster. Edema is less noticeable, and it passes more quickly.
The risk of aesthetic complications in the form of drooping ends is much lower. There are no visible scars on the skin, which for most patients is a strong argument in favor of closed rhinoplasty.
Advantages of the closed method:
- Less bleeding, less noticeable damage to the soft tissues of the tail of the nose.
- The arteries and veins responsible for blood supply to the ends are not damaged.
- The support function of the columella is preserved, there is no risk of dropping the tip after correction.
- No scars on the skin.
- Recovery after surgery is faster. Edema is less noticeable and passes more quickly.
The disadvantage of the closed method is its limited capabilities. Yes, many aesthetic problems can be solved with closed operation, but, unfortunately, not all. Revision plasty requires a full view of the surgical field, and therefore, in repetitive operations, open rhinoplasty is most often used.
Plasty tips, although seemingly simple, also often require the use of open incisions. If it is necessary to install a large implant to model the shape and correct the defect, the surgeon will need to use an external incision, as it is sometimes not possible to install a large implant through an internal approach.
The choice between open and closed rhinoplasty is largely determined by the specifics of the problem for which the patient turns to a plastic surgeon. If high aesthetic results can only be obtained with external incisions, the surgeon chooses the open method. If correction can be made through both external and internal incisions, closed operation is preferable.
You will receive detailed information on the features, disadvantages and advantages of closed and open rhinoplasty through individual consultation with a plastic surgeon.