Specific Technique Options for Nasal Surgery: The “Closed” versus the “Open” approach for rhinoplasty surgery.

There are basically two different approaches that exist and from which every rhinoplasty surgeon must choose when he or she decides to perform any rhinoplasty procedure, the “closed approach” and the “open approach.”

Dr. Sarraga prefers to use the “closed” rhinoplasty approach for almost all of their rhinoplasty procedures.

Most rhinoplasty candidates are unfamiliar with the specific types of procedures that can be chosen by their rhinoplasty surgeon to perform the actual rhinoplasty surgery. Dr. Sarraga feels that it is very important for anyone who is considering a possible rhinoplasty to be well informed as to the two options that exist, and to understand the possible advantages and possible disadvantages that exist with each of the approaches.

Again, every surgeon who performs a rhinoplasty operation must choose either the “closed” rhinoplasty approach or the “open” rhinoplasty approach when they decide to perform any rhinoplasty procedure.

The following are some of the reasons that Dr. Sarraga perfers to use the “closed” rhinoplasty approach for almost all the rhinoplasty surgeries they perform: (the possible indications and advantages of the “open” rhinoplasty approach, and the rare situations in which Dr. Sarraga might elect to use the “open” rhinoplasty approach for a particular case are explained briefly at the bottom of this page).

The first and most obvious reason that Dr. Sarraga prefers using the “closed” rhinoplasty approach for his rhinoplasty procedures is that the “closed” approach avoids the possibility of the patient ending up with a permanent visible scar across the undersurface of the nose (across the columella).

The columella is the “column” of skin situated between the nostrils on the undersurface of the nose. In the “closed” rhinoplasty approach there is no incision made across the columella. All of the actual internal surgery is performed through the nostrils using highly specialized instruments, retractors, and techniques.

Conversely, in the “open” rhinoplasty approach an incision is made completely across the columella on the undersurface of the nose. The entire nasal skin is then lifted off of the underlying nasal cartilages and bones. This allows for a more direct and somewhat easier access to the underlying nasal anatomy.

One must understand that every incision that is made anywhere and everywhere on the body will heal with a scar. The obvious goal of plastic surgery is, of course, to use fine techniques and position incisions in such a manner so that the scar will eventually (hopefully) fade and then, ultimately, become almost invisible. Unfortunately, there is always an element of unpredictability associated with the healing and final appearance of any scar, anywhere on the body, including the columella on the undersurface of the nose. Dr. Sarraga, therefore, believes that the closed rhinoplasty technique, which avoids cutting across of the columella skin, avoids the risk of any rhinoplasty patient ending up with a permanent visible scar across the columella skin on the undersurface of the nose.

A second reason that Dr. Sarraga prefers to use the “closed” approach for rhinoplasty is that since there is no cutting across of the columella skin when using this “closed” approach, the “circulation” in the skin of the nose is disrupted less. For this reason Dr. Sarraga feels that the circulation in the nasal skin remains more intact and more “normal.” This in turn may help reduce the amount of swelling that occurs after the surgery, and may also help speed the overall healing and recovery process.

A third reason that Dr. Sarraga prefers to use the “closed” approach for rhinoplasty is that they believe that when the “closed” rhinoplasty approach is used for surgery it allows them to more accurately and precisely evaluate the actual effect that any modification they make to the nasal tip cartilages will have on the “final” healed nasal appearance. This is because in the “closed’ rhinoplasty approach the intimate close attachment of the nasal tip skin to the underlying nasal tip cartilages remains essentially intact throughout the entire operation. Dr. Sarraga feels that this consideration is perhaps most important when shaping or refining the nasal tip.

Dr. Sarraga believes that the very subtle modifications of the nasal tip cartilages that must be made for the fine meticulous “sculpting” of the nasal tip, are much more accurately evaluated and appreciated when the nasal skin is still closely attached to the underlying nasal tip cartilages and bone.

With the “open” rhinoplasty approach, at the very start of the surgery, the columella skin is cut completely across. The nasal skin is then completely elevated off of the underlying nasal tip cartilages and nasal bones. The nasal skin is then frequently brought back down over the underlying cartilages and bones during the surgery to help evaluate the changes that have been made, or may need to be made to the internal nasal anatomy. Dr. Sarraga feels that this approach to determining exactly what modifications should be made to the internal nasal anatomy may be much less precise and more unpredictable than it is compared to when the “closed” rhinoplasty approach has been used (as explained above). This then is a third reason that Dr. Sarraga prefers to use the “closed” rhinoplasty approach for almost all cases.

Lastly, Dr. Sarraga feels that the size, shape and proportions of each nostril is also a very important factor to consider when evaluating the appearance of any nose. For this reason the nostril size, shape, and proportions are always very carefully evaluated before, during and after every rhinoplasty procedure.

Dr. Sarraga feels that the nicely shaped and properly proportioned nostril can be a very important part of obtaining a truly attractive, natural, and un-operated appearing nose. it is important to understand that the sides or edges of the columella make up a significant portion of the overall circumference and shape of each nostril. One can see then, that when the skin of the columella is cut completely across, as it is whenever the “open” rhinoplasty approach is used, the circumference of each nostril is completely disrupted during the surgery. For this reason. the post operative healing, shape and overall healed “final” appearance of each nostril may be somewhat more unpredictable when the “open” rhinoplasty approach has been used, as compared to when the “closed” rhinoplasty approach has been used.

As previously explained, the closed rhinoplasty approach maintains the columella completely intact throught the entire surgical procedure and, therefore, each nostril circumference remains completely intact during the surgery. This, then, may allow Dr. Sarraga to more precisely evaluate and modify each nostril as they feel may be indicated at the end of the nasal surgery.

There are, therefore, many reasons why Dr. Sarraga feels that the closed rhinoplasty approach for performing the rhinoplasty surgery is preferable to the open rhinoplasty approach for the vast majority of rhinoplasty patients. These considerations would, of course, be discussed and reviewed again during the initial consultation when one is considering having a rhinoplasty procedure.

All of these Rhinoplasty procedures are most often performed in our Office Operatory Facility, which is just “next door” to the main Aventura Hospital. They can, of course, also be performed in the adjacent Aventura Hospital, for anyone who prefers this option. The Rhinoplasty Procedures are frequently performed on an “out patient” basis. An “overnight” recovery option, however, is also available for any of our patients who might prefer this option for the first night following the rhinoplasty operation. When this option is chosen, there is, of course, a highly trained very experienced and very caring private duty Registered Nurse, as well as a experienced and caring aide that are present to care for the patient completely until the next day. At that point, most patients feel much more comfortable with the thought of going home to continue their recovery.

Open Rhinoplasty: As stated above, at the Storch Plastic Surgery Facility at the Aventura Medical Center Dr. Sarraga prefers to use the closed rhinoplasty technique for ALMOST all Rhinoplasty patients. However, our goal is always to best treat and care for each of our patients. For this reason, on rare occasions, Dr. Sarraga may suggest possibly using the “open” rhinoplasty approach for their particular case.

The “open” rhinoplasty approach allows the surgeon to have a completely unobstructed view, or “exposure”, of all of the underlying nasal structures and anatomy during the procedure. The “open” approach may allow certain specific surgical or reconstructive techniques to be employed by the surgeon that would be much more difficult, or even impossible to accomplish using the “closed” rhinoplasty approach.

In the “open” rhinoplasty approach, an incision or cut is made across the skin between the nostrils (the columella) on the undersurface of the nose. The skin on the nose is then pulled back to allow direct open visualization and manipulation of the internal nasal structures. As explained above this may make certain surgical maneuvers easier or possible during the surgery.

Learn More about Rhinoplasty

Dr. Sarraga and our staff understand that there can be many reasons to consider having a possible rhinoplasty. We are very pleased to be able to offer the rhinoplasty procedure at our Aventura Facility, which serves the Miami area. If you are considering having a rhinoplasty, or would simply like more information regarding the possible personal options that exist, please feel free to call our office at any time. It will be our pleasure to provide you with the information that you are looking for.

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