Manhattan Open and Closed Nose Surgery Techniques – Dr. Oleh Slupchynskyj
Open Rhinoplasty and Closed Rhinoplasty
The above illustration shows one phase of the Open Rhinoplasty technique, as performed by Dr. Slupchynskyj. In the illustration, a midcolumellar incision has been made between the nostrils and the nasal flap is elevated, revealing the Upper and Lower Lateral Cartilages. Open Rhinoplasty is typically performed in the sub SMAS plane of tissue. This plane is largely avascular, meaning that less bleeding occurs during the procedure; therefore less swelling occurs post-operatively resulting in a faster, easier recuperation. A shorter, easier healing time is one advantage of the Open Rhinoplasty Technique.
Another major advantage of the Open Rhinoplasty technique is visibility. As one can see from the illustration, the Open Rhinoplasty technique is precisely that: Open. Opening the nose gives the facial plastic surgeon the advantage of directly visualizing the nasal structures that he or she is working on. Naturally, since the nasal structures are exposed, access to manipulate these structures is also improved. Since Open Rhinoplasty requires more training, skill and experience to achieve proficiency, fewer surgeons are comfortable using this technique, despite the advantages. Some people will cite the incision made to the midcolumellar portion of the nose, as a disadvantage to Open Rhinoplasty. However, the midcolumellar incision, if performed and closed meticulously, heals without any evidence of scarring.
The above illustration shows the Closed Rhinoplasty technique, whereby a surgeon accesses and augments the nose entirely through the nostrils. Closed Rhinoplasty involves making an incision on the internal aspect of the nose, in the intercartilaginous area between the Upper and Lower Lateral Cartilages. The dissection (or separation of tissues) is performed blindly using a scissor, as illustrated above. The surgeon cannot see the surgical planes and dissects, without visualization, underneath the surface of the nasal flap. Since the dissection plane is obscured during Closed Rhinoplasty, the incisions and tissue manipulation can be less precise than in Open Rhinoplasty. This leads to more bleeding during the procedure and more bruising and swelling post-operatively.
The major disadvantage to the Closed Rhinoplasty technique is that it does not allow complete visualization of the dorsal septum and entire Lower Lateral Cartilages structure. Due to this limitation, the dorsal septal cartilage is sometimes trimmed inadequately, leaving a slight elevation at the caudal end of the dorsal septum, producing a Pollybeak Deformity. In some cases, the blind dissection of the nasal structures is performed poorly, leading to the buildup of scar tissue in the supra-tip area of the nose, also creating a Pollybeak Deformity. Unfortunately this complication occurs far too often in Closed Rhinoplasty procedures.
While Closed Rhinoplasty can sometimes lead to complications, there are some circumstances where it may be considered an appropriate approach. If a patient’s only complaint is a small dorsal bony hump, or a minor dorsal cartilage elevation (small bridge humps), Closed Rhinoplasty may be adequate. However, the majority of rhinoplasty procedures require better visualization of the Upper and Lower Lateral Cartilages, as well as the nasal bones. Therefore, in Dr. Slupchynskyj’s opinion, Open Rhinoplasty is the superior technique.
About Dr. Oleh Sulpchynskyj
Dr. Oleh Slupchynskyj is an highly experienced Rhinoplasty Surgeon New York City patients trust with their Nose Surgery. He is also frequently visited by Manhattan Ethnic Rhinoplasty and Revision Nose Surgery patients. Please contact Dr. Slupchynskyj today to schedule a consultation and learn more about the cost of Rhinoplasty in NYC.