There are many different techniques used in rhinoplasty surgery, and the most popular are closed (endonasal) and open (external). These terms refer to the access method used to temporarily remove the nasal skin and facilitate exposure of the skeletal framework. Virtually all changes to the outer nasal contour result from corresponding changes to the nasal skeleton, so choosing the right method is important. Both the closed and open approaches provide different skeletal exposures, thus affecting the ease of the surgery and rhinoplasty outcome.
Endonasal Rhinoplasty: The Closed Approach
With the closed approach, surgeons position all incisions inside the nostrils. By doing so, no part of the incision can be seen externally, and a visible scar is avoided. The whole surgical process is conducted through narrow openings with limited visibility because the right and left nostril incisions remain disconnected. This procedure requires stretching of the nasal skin, which means distortion of the nasal cartilage is inevitable. As you can see, surgeons are faced with considerable challenges and technical constraints due to the limited amount of surgical access.
External Rhinoplasty: The Open Approach
Different from closed rhinoplasty, the open or external rhinoplasty approach utilizes a small bridging incision, known as a trans-columellar incision, to connect the right and left nostril incisions. This allows surgeons to fold the nasal skin upward to achieve visibility of the lower nasal skeleton. Direct visibility of almost the entire nasal framework and distortion of the nasal cartilage is minimized because there is more surgical access when this surgical approach is conducted.
There are many instances where using a closed rhinoplasty approach is the more appropriate choice, but the external approach is often preferred. The open approach allows for improved accuracy and versatility. Many of the most effective techniques used in rhinoplasty surgeries today can only be accomplished by using the open approach. If you are considering Rhinoplasty surgery and have questions concerning the procedure options available, contact the professionals at Boston Rhinoplasty today for a free consultation.