Nose surgery operations are performed using closed or open rhinoplasty access. Discussions about the best rhinoplasty option continue not only in rhinosurgery forums, but also in the community of plastic surgeons. Some experts believe that most problems of an aesthetic and / or functional nature are best solved with the help of closed rhinoplasty; others have a different perspective and more often operate on patients with the open method.
Which method is better - open or closed rhinoplasty? The proposed publication discusses the main features of each variant of rhinoplasty access, the main advantages of the methods and their disadvantages.
general information
The main difference between the methods considered is the localization of the surgical approach. Closed rhinoplasty is performed through an internal access. The incisions pass through the mucosa of the nasal passages, the skin of the wings and the columella is not damaged. With this option, the plastic surgeon, in fact, gets two independent accesses to the deep anatomical formations of the left and right halves of the nasal skeleton, which somewhat worsens the visibility of the surgical field.
Open rhinoplasty is performed through external access. Incisions pass through the skin of the thin septum between the nasal passages (called columella) and the wings. A longer and, more importantly, continuous incision allows the plastic surgeon to move the skin of the tip of the nose and get an excellent view of the internal anatomical structures (cartilage, bone) that need to be changed. After correction, small scars remain at the site of the incisions, which eventually become almost invisible.
Open plastic: features of the method
According to 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 scars after surgery are hardly noticeable and after the end of the rehabilitation period it is almost impossible to see them, many are confused by the very fact of their presence. This forces patients to seek out specialists willing to perform a closed correction.
For a plastic surgeon, minimizing or completely eliminating visible marks on the skin is also of no small importance, 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 scarring, but also in terms of long-term aesthetic consequences of surgery.
Why is it important to damage the thin skin bridge between the nasal passages? Columella performs important functions. Within this anatomical formation are the blood vessels - arteries, veins - through which nutrients and oxygen enter the distal tip of the nose.
Colon arteries are responsible for tissue trophism and therefore their safety during plastic surgery affects the dynamics of the recovery period. Complementary 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 of the tip of the nose after surgery.
The second aspect relates to the fact that columella performs a supportive function. This is a kind of "support" that holds the tip in the right anatomical position. During an open operation, the supporting function of the columella may be impaired, which in theory (and in practice) in the long or medium term may lead to an aesthetic complication in the form of tip fall.
So, the main disadvantages of open rhinoplasty are as follows:
- Colon 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 the risk of an aesthetic complication in the form of falling peak.
- Small scars remain on the skin.
There is an open method and advantages. The key is that a continuous and elongated (relatively elongated) incision allows the surgeon to fully open the surgical field and have good access to the anatomical formations of the nasal skeleton. When complex manipulations in deep elements are required, a good view 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: features
Are the advantages and disadvantages of closed rhinoplasty a reflection of the pros and cons we talked about in the previous section? To a certain extent, it is.
Closed rhinoplasty is associated with less soft tissue trauma. Columella is not dissected, respectively, the veins and arteries that carry nutrients and oxygen are not damaged, and through which tissue fluid flows from the yeast. As a result, after closed rhinoplasty, healing is usually faster. The edema is less pronounced and passes more quickly.
The risk of aesthetic complications in the form of tip fall is much lower. There are no visible marks on the skin, which for many patients becomes a crucial argument in favor of closed rhinoplasty.
Advantages of the closed method:
- Less bleeding, less pronounced damage to the soft tissues of the caudal parts of the nose.
- The arteries and veins responsible for the blood supply to the apex are not damaged.
- The supporting function of the columella is preserved, there is no risk of the tip falling off after correction.
- There are no marks on the skin.
- Recovery after surgery is faster. The edema is less pronounced and passes more quickly.
The disadvantage of the closed method is its disability. Yes, many aesthetic problems can be solved with a closed operation, but, unfortunately, not all. Review plastic surgery requires a complete picture of the surgical field, and therefore, in repeated surgeries, open rhinoplasty is most often used.
Yeast plastic, 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 a defect, the surgeon should 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 mainly determined by the specifics of the problem with which the patient addressed the plastic surgeon. If a high aesthetic result can only be obtained with external incisions, the surgeon chooses the open method. If the correction can be performed through both external and internal incisions, a closed operation is preferred.
You will get detailed information about the features, disadvantages and advantages of closed and open rhinoplasty in an individual consultation with a plastic surgeon.