Rhinoplasty is one of the most popular cosmetic surgical procedures performed on the face and one of the most common cosmetic surgeries overall. Rhinoplasty is a very personal surgery because the nose is the central feature of the face. Changing the appearance of an individual’s nose can dramatically change their appearance, improving self esteem and confidence. The improved self image translates into many facets of both personal and professional life. Conversely, a bad rhinoplasty can be disastrous for the patient, and revision rhinoplasty is significantly more challenging for another surgeon. Choosing a rhinoplasty surgeon is of paramount importance to achieve optimal outcomes and avoid problems. Many plastic surgeons advertise that they perform rhinoplasty, but the strength of their training and the techniques they use vary greatly.
Early on in the evolution of rhinoplasty surgery almost all surgeries were performed through a closed technique. With a closed technique, there are no external incisions as all incisions are made on the inside lining of the nose. This gave surgeons excellent access to the upper two thirds of the nose allowing for good control in nasal dorsum surgery, or bridge work, and the ability to take down nasal humps. The lower third of the nose is constituted by the nasal tip and nostrils. With the closed technique, access to the tip is limited and subsequently modification of the tip is more challenging with this approach. There are many surgeons who get good tip results with the closed approach, but the technique left something to be desired and led to the development of the open structure rhinoplasty technique.
Open structure rhinoplasty uses different incisions than the closed technique allowing improved access to not only the tip, but all nasal structures. The open technique places an imperceptible incision in the skin of the partition between the nostrils, called the columella, and along the inner rim of the nostrils exposing all structures of the nose relevant to cosmetic rhinoplasty. This technique allowed for better tip refinement, as well as improved work on the upper two thirds of the nose.
The choice of surgical technique is dependent on the individual’s specific needs and the experience of the surgeon. Some plastic surgeons exclusively perform either the closed or open technique and others perform both techniques, allowing for a more diverse ability to shape and remodel the nose in cosmetic rhinoplasty.
Facial plastic surgeons are extensively trained in head and neck surgery during residency, gaining a superior understanding of both form and function of the nose. Some facial plastic surgeons go on to complete an additional year of training in fellowship where they intensively focus their studies and immerse themselves exclusively in facial plastic and reconstructive surgery. During this additional time they are honing their surgical skills. Dual board certified facial plastic surgeons are board certified in head and neck surgery and facial plastic and reconstructive surgery. Searching for a fellowship trained, dual board certified facial plastic surgeon who is familiar with both open and closed rhinoplasty techniques, will give a patient the greatest chance to find a very well trained rhinoplasty surgeon, with a diverse technical skill set for the best outcomes.
