The thing to understand about open rhinoplasty, which is really what I would say, 90% of rhinoplasty surgeons do. And when I say rhinoplasty surgeons, I mean surgeons that specialize in rhinoplasty. There’s probably still a few holdouts who are excellent at closed rhinoplasty, who trained doing closed rhinoplasty.
But the vast majority of us now do open rhinoplasty who recognize the benefits of being able to visualize the structure of the nose in front of us. And be accurate and precise and have so much more versatility than with closed rhinoplasty. But the critical thing to understand about that.
I think that’s where I’m at now. Is that, when you open, when you perform an open rhinoplasty, it’s a relatively destructive operation. You’re taking everything apart.
That includes the soft tissue, skin, fascia, which is the sinew that covers things, the muscles. You’re separating all of that from the structure and then separating the structure too. And what we’ve learned, what some of the great rhinoplasty surgeons of this century have begun to understand is that that destruction has to be addressed with reinforcement. It’s not good enough just to do a reductive rhinoplasty and by reductive rhinoplasty I mean taking things away. You’ve got to build things back up.
Then you’ve got to reinforce what you’ve built up. What that translates into, cause I know it’s getting technical, is grafting, grafting. And one of the things I do, is I do a lot of grafting on noses to reinforce. Not necessarily to make drastic changes, once again I think the key to a good rhinoplasty‘s a natural appearance, and sometimes that’s a subtle change.
But the grafting is to reinforce all of the structures that you’ve now reshaped because you’ve taken away all of the surrounding support system, all of that soft tissue. And that soft tissue that you then put back, the skin that you then put back, has its own forces that are gonna try to distort things. Another challenge in rhinoplasty. By reinforcing with grafts, doing a lot of grafting, that gives you a better predictability of the outcome.
That what you’ve done and what you’ve created on the operating room table is going to be and remain like that for years to come.