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Above: Before and After Rhinoplasty, photo courtesy of Dr. Golger
Rhinoplasty, often referred to as a “Nose Job” is a Plastic Surgery procedure design to alter nasal appearance and function. Although one of the main reasons people seek the procedure is of cosmetic nature, one should not forget the affect of surgery on nose function such as air circulation, breathing and potentially quality of sleep.
There are two main surgical approaches to a Rhinoplasty – Closed and Open.
Closed Rhinoplasty utilizes intranasal incisions with minimal exposure and visualization of the nasal cartilaginous and bony framework. It is an approach that relies on the surgeons’ tactile ability and imagination to appreciate the degree of needed alterations. Every patient has different skin thickness and the needed precision that sometimes comes down to 1 or 2 millimeters can be grossly over or under estimated, thus resulting in commonly seen complications of over or under-reduction of the nasal cartilages, significant irregularities and need for multiple surgeries that only make subsequent procedures more complicated.
Open Rhinoplasty also requires intranasal incisions in addition to columellar skin (skin bridge between the nostrils) incision in order to elevate the skin from the nasal framework and allow complete visualization and maximal surgical precision in alterations of the nose. This approach is also more time consuming than the Closed Rhinoplasty and thus can increase the cost of the procedure, but with potentially more benefit to the patient’s outcome.
There are a few errors that commonly occur during dorsal hump reduction that are not seen in a Closed Rhinoplasty but are very obvious in the Open approach. When removing the dorsal hump, some surgeons cut both central cartilage (nasal septum) and portions of upper lateral cartilages (nasal side walls) resulting in “Open Nasal Deformity” requiring osteotomy (breaking of the nasal bones) in order to close the nasal pyramid. Such a maneuver can result in a very narrow nasal bridge, reduced nasal pyramid and a potentially negative change in air circulation.
Any nasal tip work is also better approached via Open Rhinoplasty. Over reduction of the alar cartilages (cartilages maintaining the nostrils) can cause nostril collapse in addition to cosmetic deformity, resulting in breathing problems.
During the consultation, the patients and their surgeons should establish clear goals for the upcoming Rhinoplasty, discuss how each goal is going to be achieved in simple terms, and via what surgical approach, Open or Closed. Only by clearly defining such goals and by having patients understand how these goals are reached, one should expect a positive experience and favorable outcome.
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