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Rhinoplasty: Open vs Closed

Rhinoplasty is a complex procedure designed to improve the appearance of the nose. The operation focuses primarily on changing the underlying bone and cartilage, which make up the shape of the nose. Of prime concern to the operating surgeon Dr. Warren Lent, is how best to expose these structures, while at the same time maintaining the integrity of the nose. There are two basic techniques used to perform modern day Rhinoplasties: the "Open" and "Closed" approaches.

The "closed" technique is characterized by the operating surgeon making all of the incisions on the inside of the nose. The obvious advantage for this technique is that there are no visible incisions. All incisions are well camouflaged inside the nose. Also, the external skin remains undisturbed, thus Dr. Lent can continuously assess the nasal shape after each phase of the procedure. The prime disadvantage to the "closed" technique is that it greatly limits the surgeon's ability to visualize all of the underlying structures.

The "open" technique employs many of the same internal nasal incisions used in the "closed" approach, but adds one important additional incision. This extra incision is placed on the undersurface of the mid-portion of the nose, at its narrowest point. This extra incision is very difficult to see by anyone who looks at the patient after surgery, as it is on the underside of the nose in a position where no one typically looks. The major advantage of this added incision is that it affords the surgeon the opportunity to easily visualize the nasal cartilages and bones. This enhanced visualization allows Dr. Lent to more accurately correct deformities of these structures.

A Rhinoplasty requires a Plastic Surgeon to remove, add or reshape the cartilage and bones of the nose. Precision is of utmost concern to Dr. Lent. Often fine adjustments are all that is needed and the surgeon's ability to see exactly what is being removed or added is essential to the outcome of the procedure. Sometimes cartilage grafts taken from inside the nose, ear or rib, will need to be added to the nasal structure. The "open" approach allows for suturing of these grafts into the exact spot required. At times, nasal cartilages are the correct size but may need to be reshaped with the use of permanent sutures. The "open" approach is often the best way to apply these permanent sutures.

Nasal surgery is often considered to be the most difficult and complex of all of the procedures commonly performed by board certified Plastic Surgeons. The ability to accurately perform this procedure is essential to its final outcome. During your consultation, Warren Lent, MD will carefully assess and recommend the procedure that is best suited for your individual needs.