Perhaps one of the most confusing dilemmas confronting the prospective rhinoplasty patient is the choice of open versus closed rhinoplasty. These terms, while puzzling, simply refer to the two possible surgical approaches — that is, the access method used to temporarily remove the nasal skin and facilitate exposure of the skeletal framework.
Unlike the closed rhinoplasty, the open or external rhinoplasty approach employs a small bridging incision, called a trans-columellar incision, to connect the right and left nostril incisions. In exchange for this 4-5 mm visible segment, the nasal skin can be folded upward (similar to opening a car hood) and unimpeded visibility of the lower nasal skeleton can be achieved. In addition to direct visibility of almost the entire nasal framework, distortion of the nasal cartilage is minimized and individual components can be evaluated in their natural, undisturbed alignment. Thus, the hallmark of the open rhinoplasty is the vastly improved surgical access permitted by the trans-columellar incision.
In the closed rhinoplasty approach, also called endonasal rhinoplasty, all of the surgical incisions are positioned inside the nostrils. Although parallel incisions encircle nearly half of the nostril lining, no part of the incision can be seen externally and a visible scar is avoided. However, because the right and left nostril incisions remain disconnected, repositioning of the nasal skin is difficult and the entire operation must be conducted through narrow surgical openings with limited visibility. Because access to the nasal framework requires vigorous stretching of the nasal skin, distortion of the nasal cartilage is also inevitable. While a visible scar is prevented, considerable challenges and technical limitations are associated with the relative lack of surgical access. Hence, closed rhinoplasty merely refers to the relative lack of surgical exposure associated with the endonasal approach.
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