open versus closed rhinoplasty

Dr. Conrad discusses open versus closed rhinoplasty - careful distinction, an experienced decision.

Dr. Conrad uses both open and closed rhinoplasty to reshape the nasal tip. Here is a brief description of each method for the benefit of a prospective rhinoplasty patient. The choice depends on the patient's nasal anatomy, clinical requirement and is very important for maximizing the rhinoplasty result.

Open rhinoplasty
Dr. Conrad makes a small incision across the columella (soft tissue between the nostrils). The resultant scar becomes virtually invisible within 6 months. Please see the enclosed patient's photograph with the incision marked before the operation and the healed scar.

Closed rhinoplasty
All of the incisions are inside the nostrils. Each approach has benefits and drawbacks.

How does Dr. Conrad decide which approach is right for you?

Open rhinoplasty considerations

Open rhinoplasty allows the surgeon the advantage of being able to safely gain access to the nasal tip even in patients who have had considerable scarring and damaged nasal anatomy following previous unsuccessful surgeries. Open rhinoplasty is valuable in adjusting and correcting the nasal shape with an extra degree of control and precision when application of grafts or implants is necessary. It may be helpful in patients who demonstrate some anatomical variants in the positioning (orientation) of alar tip cartilages.

Closed rhinoplasty considerations

One advantage of close rhinoplasty is reduced time of surgery, possibly reduced swelling, reduced postoperative healing time and elimination of a scar along the columella. In patients whose nasal profile requires only slight tip reshaping, postoperative swelling can be almost gone within two weeks. With the patient's input, Dr. Conrad's goal is to obtain the optimal result possible. Most patients realize that their ultimate result - the one they will have forever is the main issue, rather than the swelling that occurs during healing.

In conclusion

Patients seeking rhinoplasty are best served when the surgeon has significant experience in both methods and can choose the appropriate technique with preference based on patients' needs rather than his own prejudice. Most individuals requesting a rhinoplasty are suitable candidates for a closed technique and can expect such an approach offered to them by an experienced rhinoplastic surgeon. Patients who had previous nasal operations, at times multiple, with deformities requiring complex surgical manoeuvres and the use of grafts are likely candidates for open rhinoplasty.

In brief, closed rhinoplasty offers the benefits of less down time and swelling while open rhinoplasty can be required in cases of complex structure or variation in nasal anatomy.