Rhinoplasty is the surgical reshaping of the nose. It is probably the oldest plastic surgical procedure, going back to ancient India. In it’s modern reincarnation, it is still probably the most challenging operation surgeons perform. Its successful execution requires skill as well as a keen eye for aesthetics and facial proportions. Experience and clinical excellence are key for best results.
Prospective patients often ask whether I will perform an “open” or a “closed” rhinoplasty.
Once upon a time all rhinoplasties were “closed”, that is, the surgery was performed through one nostril. This is a simplification, actually, but essentially, there were no visible scars. Expertise required a lot of practice and the learning curve was steep. Even teaching the technique was difficult, since it’s tough to get more then one person at a time to see up one tiny nostril. Because of these limitations, the technique of “open” rhinoplasty became popular.
In “open” rhinoplasty technique, an incision is made in the base of the columella (the structure that separates the nostrils), and then extended into the rims of each nostril to allow the skin of the nose to literally be peeled from the underlying structures. This allowed the techniques to be performed visually, with the added advantage that it could be easily taught to others. It also allows the use of complex cartilage-grafting techniques to be able to better predict a more favorable outcome.
The principle disadvantage of open technique is that it produces more scar tissue. We are finding that, with time, scar tissue results in a fallout of fat tissue; this results in what is called “skeletalization.” Just like it sounds, this iisn’t a good look, because the nose looks thin and bony. In my practice I perform both techniques since I am familiar well with both of them. Most of my rhinoplasties are endorhinoplasties or “closed”, since most primary surgeries are reasonably straightforward. If the nose is more complex or grafting techniques are to be used, then I will opt for an “open” technique. It is nice to have a choice.
I prefer general anesthesia for this procedure and I also feel it is much safer to have it done this way. An uncomplicated rhinoplasty takes from 1 to 2 hours and the postoperative course is difficult for the first few days because of the packing in the nose. When it is removed in 3 or 4 days, then things are much better. The splint or “cast” is removed in one week; the most exciting thing about this is that you see your new nose for the very first time. I tell my patients that this is pretty much what your nose will look like once it heals completely. There is virtually no pain experienced with this procedure. Secondary surgeries or reoperations are seen in about 30 percent of cases attesting to the complex nature and intrinsic challenge of rhinoplasty.