There are two basic types of rhinoplasty: open and closed. During an open rhinopasty, an external incision is made in the columella (the area between the nostrils), whereas during a closed rhinoplasty all incisions are made through the nostrils, inside the nose. The closed rhinoplasty approach has virtually all the same incisions as the open approach, with the exception of the small stair-step incision on the columella.
The closed rhinoplasty is the traditional technique, and is more commonly performed when the primary goal of the rhinoplasty is to address bone abnormalities such as a dorsal hump (see the various cosmetic and medical modifications possible here). The closed rhinoplasty procedure is extremely common when it comes to nose jobs and offers the desired results, but only when minor reshaping is needed, or have features that are easily corrected. It is commonly used when the tip of the nose has good shape and is not too long, too wide, over or under projected. The incision during this approach is not visible after surgery because it is made on the inside of the nose.
There are advantages to having a closed procedure, including: no visible scarring, less pain, less bruising, less postoperative swelling, a shorter recovery period, and very little pain (see here for description of detailed recovery process). It is often the best approach to begin with for optimal rhinoplasty results. But for other more severe cases, the open nose job technique will be recommended. The closed procedure is inferior in the degree of visibility of the nose structures that are being reshaped, and may create unnecessary complications. Despite this disadvantage, some patients are uniquely suited to the use of the closed approach based on the thickness of their skin, cartilage quality and the area of the nose requiring the greatest degree of refinement.
The procedure requires anesthesia. Once the hidden incisions are made inside the nose, the skin covering the nasal bones and cartilage is gently raised to allow the surgeon access in order to reshape the nose in the desired manner. Depending on the individual case, tissue may be removed or added before skin is redraped over the nose. Once the rhinoplasty has been completed, the inner nose will be stitched closed, without packing, and externally splinted or casted.
Most closed rhinoplasty operations usually take about two weeks to settle. There will be no external scarring, but if a nose is broken as part of the surgery there will be noticeable bruising around the eyes for about seven-to-ten days, with yellowing around the eyes for 10-20 days. Please see the post-surgery instruction section for more information about the recovery process.
Rhinoplasty surgery includes the following steps:
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation or general anesthesia. Your doctor will recommend the best choice for you.
Step 2 – The incision
Rhinoplasty is performed with incisions hidden inside the nose. Through these incisions, the skin that covers the nasal bones and cartilages is gently raised, allowing access to reshape the structure of the nose.
Step 3 – Reshaping the nose structure
An overly large nose may be reduced by removing bone or cartilage. Sometimes surgery of the nose may require the addition of cartilage grafts. Most commonly, cartilage from the septum, the partition in the middle of the nose, is used for this purpose. Occasionally cartilage from the ear or rarely a section of rib cartilage can be used. Additional incisions may be placed in the natural creases of the nostrils to alter their size.
Nasal reshaping and resizing: A variety of procedures can be performed to obtain desired shape and size of the nose. Some of the most common aesthetic concerns are a dorsal hump, a wide tip, or a crooked nose. Dorsal hump reduction involves removing both bone and cartilage from the roof of the nose to create a more aesthetically pleasing profile. Tip reduction can involve removal of cartilage in the nasal tip and use of sutures to reduce the size of the nasal tip cartilage. Straightening a crooked nose may involve any of a variety of techniques, including osteotomy (breaking the nasal bones) to create more symmetry on frontal view.
Step 4 – Correcting a deviated septum
If the septum is deviated, it can be straightened and the projections inside the nose reduced to improve breathing.
Correction of nasal obstruction: In functional rhinoplasty, there are 3 primary components of the nose that are evaluated for repair: the nasal septum, the inferior turbinates, and the valves. If there is deviation of the septum (a structure that divides the 2 sides of the nose internally), this is repaired by removing or reshaping the deviated component. The inferior turbinates, when enlarged, can obstruct the airway and thus may require surgical reduction. The nasal valves refer to the narrowest point in the entrance to the nasal cavity and can be augmented in a variety of ways to increase the size of the opening and prevent collapse during inhalation.
Step 5 – Closing the incision
Once the underlying structure of the nose is sculpted to the desired shape, and the surgeon is satisfied with the appearance of the nose, nasal skin and tissue is redraped and incisions are closed. Splints are usually placed outside of the nose to maintain stability during the early healing process. In cases of septal surgery, intranasal splints are often used.
If you are unhappy with the appearance of your nose, or suffer from medical issues with your nose, we invite you to contact our nose surgery service today. You can find the answers to the most frequently asked questions here. Your doctors in Korea will provide a comprehensive medical history and Rhinoplasty analysis that will allow them to provide each patient with an accurate diagnosis so that a patient-specific treatment plan can be put into action. Contact us now.
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