A comment on a previous post asked me whether the surgery was “open” or “closed” and why. It’s a great question that I think needs an explanation, so here it is!
My own philosophy around this is that I believe I can better control shape and therefore the outcome by using an open approach. An open approach has a set of incisions including one external incision, while with the closed approach, the set of incisions are all inside the nose.
The 100% closed rhinoplasty proponents will say that the external scar is conspicuous and best avoided. To be honest with you, this argument unnecessarily plays on patient fears. If put back together well (I put about 9 dissolving sutures along the transcolumellar incision), it heals incredibly well. Makeup can be placed on it at 2 weeks, but in reality, most patients just let it go bare since it’s in the shadow of their nose. At the 1 month visit, it is often red or hyperpigmented but fades by the time I see patients at 4 months. So somewhere between 1 and 4 months it essentially becomes invisible. Sure, if you look closely under magnification you can see it, but it is truly one of the privileged places on the body where scars heal consistently well.
In addition, with few exceptions, tip work can be more precise when you are able to see better and open surgery allows for vastly superior visualization. This also goes for revision rhinoplasty, where complex techniques can be employed. Now the flip side of this is that because you can see more, a novice or inexperienced surgeon may end up doing more and cause some problems as a result. So like in all things, there is a balance. Just pick someone who does a lot of noses!
An open rhinoplasty takes longer but that’s really just a downside for the surgeon. It usually takes me about 3 hours of operating time to do one primary rhinoplasty (add 1-2 hours for revisions), while you can bang out 4 or more endonasal (closed) rhinoplasties in a day. However, it’s not a race when it comes to your face (just made that up; trademark pending).
So for me, open is the way to go over 90% of the time. On occasion I will do closed surgery but only when patients are happy with their tip (shape, projection and rotation) and just want a change to the bridge of their nose. This is the one time where there is a true advantage because you can bypass the tip and therefore not affect it surgically. This allows for very fast healing since the skin is not lifted off of the tip cartilages and doesn’t swell as much.
In the end, different surgeons with different philosophies can get great results. So check out their photo galleries. If you see that they create consistently beautiful noses (especially the tips), then go with that person. It’s very likely that that surgeon utilizes the transcolumellar open incision approach.