Open Rhinoplasty vs Closed Rhinoplasty

There are differences between open and closed rhinoplasty. The biggest  difference is about in which cases they need to be used, because they both have  advantages and disadvantages. Generally, for primary cases, the closed  approach is preferred. Because within closed approach, the healing process is  easier and faster. The reason for that is the nose recieves less trauma which  leads the nose to have less swelling especially during the first acute healing  stage.  

However, if the nose is a revision case, meaning if the nose was operated before,  due to any kind of reason, for example; a septoplasty or a breathing issue  correction. Then, the best strategy here is to proceed with open rhinoplasty  technique, because we need to see the nose from all angles in order to  understand what was performed and what can be performed to construct it best. If too much cartilage is removed from the nose in the primary, and we will be  needing spare cartilage from elsewhere in the body for the revision surgery, an  open technique is preferred, because the whole nose should be seen 360 during  such a difficult case.  

There are also other reasons where an open rhinoplasty approach might come in  handy. If the patient has extreme deviated septum or an ethnic rhinoplasty case,  where the nose is very looks a bit flattened or compressed, or if the case is very  complex, we might need an open rhinoplasty approach to be able to see the nose  from all angles.  

In order to create more visibility a small incision on the collumella is applied, but  in closed rhinoplasty technique, the incision are made inside the nose. 

In closed rhinoplasty, as the procedure is performed through one of the nostrils  and the outer skin of the nose stays tucked and it is not touched, this creates  advantages as mentioned above. The closed technique is appropriate if the nose  hasn’t been operated before. We can perform what we need to do without  opening up the nose totally. The incisions to reach the operation area are made  from the inner sides of the nose. This creates an easier reach to our target area.  And when we do not create bigger incisions, it means we give less trauma to  nose and that will effect the facial and nasal swelling in a positive way. However,  the disadvantage here is that the eye sight of nasal structure is weaker and we  would not be able to get the full picture. But when you are in safe hands, this no  longer is a concern. Closed rhinoplasty technique should always be performed by  surgeons who are experts in rhinoplasty.  

Right after the surgery, the patient wakes up with a cast on the nose and inner  splints. The splints are removed on the 3rd post operative surgery day and the  cast is removed on the 7th post operative surgery day. In both approaches, the  

facial swelling will start to ease from the 3rd post op day. Of course, the swelling  takes longer in open rhinoplasty approach. 

The facial swelling wears off around 10 days in closed preservation rhinoplasty  technique but in open rhinoplasty, it takes around 14 days. But, the important  question here is that if the open rhinoplasty will give better results for your case,  no matter the swelling, the patient should proceed with that option where the  surgeon feels that specific approach will give better results. 

Once one month has passed since the rhinoplasty surgery, we might see the  nose being more swelled in open technique than the closed technique. (If the  patient has a thick skin and had an open rhinoplasty technique performed then,  this might even take longer.) There is no pain left on the nose, however in both  cases the nose might feel stiff and numb in some areas of it. 

Around 3 months time, the nose will start to settle in its place and the swelling will  look less. Of course, compared to closed rhinoplasty, the swelling on the nose  might be more but the aim here is to end up with the best possible result and for  us to apply that, the surgeon needs to use the best technique.  

Especially in extreme cases like reconstructioning the nose from scratch or an  etchnic case, the final result of the surgery can take even longer than 1 year  regardless of the applied technique. But, these types of cases which need more  expertise are generally performed via open technique where we get to see the  whole structure of the nose at once.  

Another difference between the healing stages is about the scar, as there is scar  on the outer part of the nose in open rhinoplasty technique, it takes time for it to  heal just like any scar in the body. After 6 months post surgery, the nasal scar will  start to look more faded and will continue to get fader in time. 

To sum up, both techniques have their pros and cons, the key here is to decide  which technique suits which case. If the surgeon is facing a difficult case, where  reconstruction of the nose is needed or the nose has very thick skin and the  inside of the nose needs to be evaluated closely and if the whole nasal structure  needs to be investigated, then open technique would be best of use here. The  surgeon should decide if its worth to open up the nose or not. 

However, if the nose does not have thick skin or it will be the first time this nose is  being touched, then closed approach would be best because the case is probably  easier compared to other reconstruction cases where we do not need to  investigate the full structure.

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