Structural And Excisional Nose Job Open Vs. Closed Rhinoplasty

By Jerome Edelstein, MD

Structural (or incisional) rhinoplasty refers to the modification of the nose by changing the shape and position of the nasal tip cartilage. This process leaves the skeletal framework of the nose strong and relatively intact, helping to make treatment safer, predictable, and more accurate. If any tissue is removed, particularly when fixing an oversized nasal bridge, hump or bulbous tip, it can also be referred to as excisional rhinoplasty. The excisional technique involves the removal (or excision) of some of the cartilage and other tissue found in the nostril and/or tip of the nose during the reshaping process. By removing this cartilage and tissue, the contours of the nose are enhanced. However, experienced rhinoplasty surgeons like Dr. Fialkov limit the amount of tissue that is cut out, removed, and discarded in order to preserve the skeletal support structure of the nose during the remodelling process. Serious aesthetic and medical complications may not become fully apparent for months, years, or decades when too much tissue is removed, but have commonly been found to develop over time.When too much tissue is taken away, the remaining nasal cartilage will often buckle due to skin shrinkage and/or begin migrating upward as the scar tissue contracts. This can happen immediately or gradually. Other problems include retracted nostrils, overly prominent nostrils, and a pinched or artificial looking outcome. The end result is a deformed nose that may require further treatment to correct.OPEN VS CLOSED RHINOPLASTYIn the past, the rhinoplasty procedure was generally limited to reducing the size of certain structures of the nose through excision only. This was performed by creating an excision, for the most part, through a closed or “blind” approach. The surgeon was not able to directly see the structures and tissues that they were modifying, which increased the risk of an undesirable outcome.

The open approach septorhinoplasty allows for direct visualization of each structure of the complex nasal anatomy. This allows your surgeon to make more predictable changes under direct vision, such as the following:

increasing size where needed

changing shape or contour by means of grafting or suturing techniques

reducing the size of structures

The open approach allows for greater precision and in turn greater predictability of outcome. It allows your surgeon to perform a more structural rhinoplasty, whereas a closed rhinoplasty is often limited to excision. Excision may still be part of an open rhinoplasty if any part of the nose needs to be reduced in size. Being able to properly view the operating site makes it possible for cartilage grafts to be accurately placed, immobilized with sutures and hidden from view, ready to heal into a strong, beautiful looking nose.

Dr. Fialkov will be able to augment your nose in a way that both looks fantastic and is able to withstand the test of time.