Rhinoplasty Procedure – Cosmetic vs Functional


We’re talking about rhinoplasty. Last time we talked about, why do people seek a rhinoplasty? or who’s a good candidate for rhinoplasty? We talked about the aesthetics or the shape and appearance of the nose versus the function of a nose. How easily do I breathe and does that need to be modified? The other thing we need to talk about is what actually happens during a rhinoplasty? How is it done? Well, there’s a lot of different ways to do a rhinoplasty if it’s combined with the breathing component, the septoplasty part of it, it adds a little bit of complexity.

Basically there’s two ways that most surgeons would approach a rhinoplasty. You may have heard the term open versus closed or endonasal, which is closed, versus an open technique. What are the differences? Well, it really has to do with the incisions an endo rhinoplasty or a closed rhinoplasty there’s no external incision. All the incisions all the work is done from inside the nostrils so there’s nothing on the outside.

That adds a level of complexity and probably a little less accuracy, maybe that’s the best term, especially when you’re dealing with the cartilage it forms the tip of the nose. Most plastic surgeons in this country especially if we’re dealing with the tip of the nose and the complex cartilage that involves the tip, we’ll do an open approach. So, what’s the open approach? Where are these incisions? Well, they’re still mostly inside the nostril but they connect across this part of the nose right here. We call that the collagen mela and then it includes an incision inside each nostril.

Why is that important? Well, it adds a significant amount of exposure to surgeon when we make an open rhinoplasty incision is able to peel all the skin, fatty tissue, off of the framework of the nose. That’s the bone and cartilage. We can peel everything up and have it all exposed. It’s like taking the rainfly off of your tent you’ve got the tent poles exposed there. Then you can easily see the poles. You can modify them to the shape that you want.

Procedure - Cosmetic vs Functional
Procedure – Cosmetic vs Functional

Drape the skin back down just like you throw the rainfly back on your tent and you can see the shape and if you’re not satisfied yet, you can pull the skin back off and re-manipulate the cartilage and sometimes it can take different techniques, whether it’s suturing techniques, cartilage grafting techniques, maybe you need to do a little bit more, a little bit less, and then you can continue to re-drape the skin, step back and see if you’ve achieved what you’re hoping for or what the patient is desiring.

That’s the advantage of the open. The disadvantages you have about five millimeters of an incision on the outside of your nose. The reality of that in 22 years of practice, I’ve never had somebody complain about that.

They tend to heal beautifully if they’re designed correctly; very, very inconspicuous not a part of the space that’s paid attention to I guess when you’re talking to other people. So, it’s just inconsequential but the added benefit of the surgeon, especially for dealing with the cartilage here at the tip, can be significant. So that’s the difference between an endo or an open versus a closed technique. I hope that answers your question about that issue about rhinoplasty. Come on in and talk with us.


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