Open rhinoplasty: should you be afraid of the external incision?
Many patients are frightened by the external incision, as in closed rhinoplasty all incisions are made inside the nose and are not visible from the outside. In open rhinoplasty, a step-like incision is made on the skin bridge between the nostrils (the columella).
With careful and precise alignment of the wound edges, this scar becomes barely noticeable within a few months and disappears within 6 months to a year. You can verify this by viewing the gallery of my work. Take a close look at the columella at different times after the surgery. For particularly suspicious individuals, I can always provide the original photographs to ensure the absence of “Photoshop”. All these results are achieved exclusively using the open technique.
Logical arguments in favor of the open technique:
- Absolute visibility: Open access provides complete visual control over all nasal structures, whereas in closed rhinoplasty, it is limited.
- Maneuverability: With open access to the nasal septum, the surgeon has a better view and freedom of action.
- Less bleeding: Postoperative bleeding after open rhinoplasty is reduced because the mucosa is not damaged.
- Reliable cartilage fixation: Open rhinoplasty allows for the extensive use of cartilage autografts and their stable fixation. This greatly expands the surgeon’s capabilities in complex and non-standard cases.
- Limitations of the closed method: Closed rhinoplasty, conversely, limits the use of cartilage autografts due to unstable fixation.
- Less pronounced swelling: Postoperative swelling after open rhinoplasty is less pronounced compared to the closed method, as tissue dissection is performed under direct visual control, allowing it to be done very carefully and deeply.
- Working with thick skin: In patients with thick skin, the open approach allows for the thinning of the skin in the tip area under direct visual control without disrupting the blood supply to the skin.
Duration of the surgery or a better result?
Many proponents of closed rhinoplasty cite a shorter surgery duration as a major advantage of the closed method. Yes, this is true. Closed rhinoplasty can be done in 30–40 minutes. The duration of open rhinoplasty is 1.5–2 hours.
In such cases, I always ask patients:
“What is more important to you — a short duration of the surgery or a better result?”
