Rhinoplasty Techniques: Open Rhinoplasty

A nose job, or rhinoplasty, can be done in either of two ways, open or closed. In open rhinoplasty, there is an incision on the outside of the nose. In closed rhinoplasty (link to URL), incisions are made on the inside of the nostrils, where they are hidden.. An open rhinoplasty is sometimes referred to as an external rhinoplasty, while a closed rhinoplasty is sometimes called an internal rhinoplasty.

If all things were perfect, the best rhinoplasty would leave absolutely no scars. However, any incision into the body leaves a scar of some sort and the trick is to minimize the scarring or to place incisions where any scars will not be visible. Incisions inside the nostril, as in a closed rhinoplasty, would fit that requirement and many rhinoplasties are done that way.  However, not all rhinoplasties can be done through incisions inside the nostrils. Many plastic surgeons prefer to use an open technique because it gives them a better view of what they are doing.

In an open rhinoplasty, the surgeon makes an incision at the bottom of the nose, across the columnella, which is the bottom of the septum, the vertical wall between the two nostrils. The skin of the nose is then pulled up and over the nose and held out of the way with an instrument called a retractor. The surgeon can then see the cartilage and bones of the nose and can make any adjustments and changes to their shape.

The incision across the bottom of the columnella is either shaped like a V or a W. This incision is made very close to where the nose joins the skin of the upper lip. The incision is closed with tiny sutures after the surgery. Sutures are usually removed in a few days and in most cases the scar will shrink and become pale within a few months. After you are completely healed, the scar is very inconspicuous and will be visible to others only if you were looking straight up at the ceiling, if then.

Any surgery that involves adjusting the size of the nostrils requires an incision at the outside edges of the nostrils, where any scars will be buried in the crease on the side of the nose. In rhinoplasties that involve adjusting the size of the nostrils and external incisions, the surgeon may go with an open technique since there will be an exterior scar anyway.

Occasionally, a surgeon who is planning to perform a closed rhinoplasty has to convert to an open technique during the surgery. This may be necessary due to the presence of scar tissue or because the surgeon feels that he or she needs a better view of the nasal structures to make all the corrections necessary.

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