On this page we provide an overview of the various rhinoplasty techniques. This should answer many of your questions and prepare you for a consultation with your plastic surgeon.
In rhinoplasty, excess cartilage and bone are removed from under the skin that covers your nose. Sometimes the surgeon will need to reshape and reinforce the structure of your nose using cartilage or bone grafts. Afterward, the surgeon places the skin back into position over this remodeled framework, giving your nose a new look. Depending on your unique needs, your nose may now be larger, smaller, shorter, longer, or have had enhancements made to the bridge, tip or nostrils.
If you've never before had nasal surgery, you may hear this surgery referred to as your "primary" rhinoplasty. It can be performed for aesthetic, functional or reconstructive reasons, or a combination of all three.
The two most common techniques are "open" and "closed" rhinoplasty, but there are other variables to consider. Only after examining your nose, diagnosing the problems, and making a plan to correct them, can your surgeon decide whether the open or closed approach will be best for you. Good surgeons will achieve great results with either method.
In a closed rhinoplasty, all incisions are made along the inside of the nose, making this the most popular option with patients. The closed technique limits the surgeon's visibility because all of the work is done inside the nose, but the fact that there are no external incisions offers some distinct advantages over the open alternative:
- Lower risk of nasal tip swelling
- Reduced risk of surgery-related complications or infections
- Reduced risk of swelling and edema after surgery, leading to a faster recovery
- Shorter surgery time, resulting in less anesthesia
- No external scars.
This technique uses the same incisions as a closed rhinoplasty, plus one additional incision on the outside of the nose in the tissue that separates the nostrils, called the "columella". By making this additional incision, the surgeon is able to peel back the skin of the nose and entirely expose the structure inside.
While the open technique creates this small incision on the exterior of your nose, leaving the potential for scarring, it usually heals well and is barely, if at all, noticeable. Some of the advantages of open rhinoplasty are:
- Better visibility for the surgeon
- Unobstructed access to the framework on the interior of the nose
- Surgeon can make a better diagnosis and "fine tune" the nose during surgery
- May be the best choice for complex deformities.
The majority of people who undergo reconstructive nose surgery will be happy with their new nose and only need primary rhinoplasty. However, a minority of patients (5% to 20%) are dissatisfied with their results.
If you find yourself in this predicament, you may need a revision rhinoplasty, also referred to as a secondary rhinoplasty. A revision rhinoplasty is any nose operation that is performed to correct, revise or improve upon the results of a previous procedure.
The main reasons for dissatisfaction with primary rhinoplasty are:
- Mistakes made by the plastic surgeon
- Lack of communication between doctor and patient as to expectations
- Persisting breathing problems
Secondary rhinoplasty surgeries are typically more complicated than primary ones. Because of this, it is typically performed using the open technique, which makes the nose more clearly visible and accessible to the surgeon, allowing him or her to more easily see and correct nasal deformities.
Visit our page which focuses on Revision Rhinoplasty to learn more about the technique, what you can expect, and how to choose the right surgeon for the procedure.
Which Technique is Right for Me?
Although you may have already decided which technique you prefer, your surgeon will recommend the most appropriate approach after evaluating your goals and any nasal problems you may have.
In general, closed rhinoplasty is usually preferable if your nose is smaller and has a small bridge and tip. If you are looking for only minor changes, such as to correct a very small hump, your surgeon may also recommend the closed technique.
Open rhinoplasty, on the other hand, may be a better option for larger noses with a longer bridge or more bulbous tip. If your nose is too long, or crooked, or has a drooping, over-wide, asymmetrical or otherwise unusual tip, the best option for you might be open rhinoplasty.
Patients who have had previous nasal surgery and need a secondary, or "revision", rhinoplasty will likely require the open technique.
Whether you have an open or closed rhinoplasty, the procedure will cause a certain amount of bruising and swelling. Read our guide on Rhinoplasty Recovery to find out what you can expect after surgery.