Q: I’m thinking of having a rhinoplasty. I’ve gone to a few doctors and heard different opinions. Some tell me the only way to do my nose is with an open rhinoplasty. Others tell me I can it can be done open or closed. What is your opinion of the way I should do my rhinoplasty?
A: Rhinoplasty or cosmetic surgery of the nose is a very complicated procedure. Two approaches can be taken and every surgeon who operates on patients should be comfortable with both procedures.
Closed surgery is done through the nose (endo-nasal) while the open approach makes an incision in the columella area that separates the nostrils, elevating the entire skin over the nasal cartilages and bone. Because the open approach disrupts many stabilizing factors of the nose tip, it must be reconstructed, grafted or improved. Either approach is satisfactory, as long as the surgeon is comfortable performing surgery suited to each individual. What is often wrong is performing open rhinoplasty when it isn’t needed.
Open rhinoplasty was primarily designed for patients who have wide nose tips, requiring grafts because of previous incompetent surgery, or the need for reconstructive surgery of the nose tip itself. Because of the complexity of rhinoplasty surgery, the open approach has become routine for physicians who find it easier to perform that procedure for patients who have a bump along with a very nice nasal tip which may only need minimal change. That is when I perform a closed rhinoplasty. If your nose has a wide nasal tip, is over-projected by protruding far from your face, or you have a poor rhinoplasty needing to be redone, I recommend the open rhinoplasty procedure. Few if any noses are created equal and that’s why different approaches should be considered before choosing the procedure appropriate for each patient.
Dr. Carlos Wolf is a partner in Miami Plastic Surgery and is board certified. Email your questions to him at firstname.lastname@example.org or call 305-595-2969.