Rhinoplasty methods: open and closed rhinoplasty

Consultation with plastic surgeons with over 20 years of experience – free! Sign up by phone. Waiting for you! Closed rhinoplasty is a technique for plastic surgery of the nose using an endonasal (closed) approach. The fundamental difference between closed rhinoplasty lies in the name itself: all incisions are made exclusively inside the nose.

In an open nose job, the surgeon makes an incision at the base of the columella (the area of ​​skin between the nostrils) and inside each nostril. This method allows you to completely visualize all the structural elements of the nose and carry out even the most complex correction with maximum accuracy. In many cases this is the recommended technique. The incision in the columella area becomes indistinguishable within a few months.

In closed rhinoplasty, the surgeon makes incisions inside the nostrils: thus, there are no visible external incisions to begin with. However, this method of operation is practically not applicable in solving some problems of rhinoplasty.

Closed rhinoplasty is not recommended if a nasal implant is to be installed, as well as in some cases of revision rhinoplasty. Not all surgeons can use closed rhinoplasty: a highly qualified doctor and extensive experience, impeccable knowledge of anatomical structures and the ability to work with minimal visualization of the surgical field are required.

The surgeons at the Mont Blanc Clinic are fluent in all methods of nose surgery. However, the patient’s desire to undergo closed rhinoplasty is feasible only with a positive verdict from the doctor. The doctor evaluates the surgical plan and makes a decision depending on the specific situation.

Why do we choose closed rhinoplasty?

Of course, the type of access during rhinoplasty is chosen exclusively by the doctor and solely according to the indications of a particular patient. Surgeon's tasks:

• carry out a full nose correction
• minimize all traces of intervention.

After closed rhinoplasty, there is not a single visible scar left on the facial skin, since all the incisions are made inside the nasal passages. At the same time, the operation allows you to fully work with the internal tissues of the nose, adjusting their size or shape. This is why surgeons at the GALAXY Beauty Institute choose closed access in the vast majority of cases.

Which method do I choose?

Today, in my practice, endonasal rhinoplasty takes precedence. I have been practicing plastic surgery for more than 12 years – years of continuous work and study in this complex area of ​​aesthetic medicine. It is the long-term continuous process of mastering the skill of a rhinosurgeon that allows me to feel confident and offer patients the low-traumatic technique they so desire.

But there are a number of situations when I will make my choice in favor of open surgery:

• revision rhinoplasty
• patient's history of serious trauma
• reconstruction of the nasal dorsum or cartilage
• work with deep sections of the septum

This is dictated by the need to expose as many elements of the nose as possible and to carry out correction on tissues with existing scar changes, which is considered additional difficulties in surgery.

⇒ INFORMATION: Medical indications for correcting the shape of the nose

Peculiarities

Modern technologies and high-tech equipment have reached such a level that doctors at the GALAXY Beauty Institute can control all stages of closed rhinoplasty.

• When manipulating the tip of the nose, you can bring the cartilage into the incision and freely adjust its shape.
• When working with the back of the nose, special tools are used, equipped with fiber-optic illumination and a headlamp with a narrow directed beam.
• When performing closed rhinoplasty, video technology is used - an endoscope. The image from a miniature camera on a flexible probe is displayed on the monitor for a full examination of hard-to-reach areas.

Maintaining the integrity of the skin throughout the operation makes it possible to easily see how manipulations inside the nose are reflected in its appearance.

Rehabilitation period

At the end of the nose reshaping operation, the surgeon applies a fixing plaster. It prevents bones from shifting, and the bandage controls swelling and nasal discharge.

The doctor prescribes painkillers for up to 5 days. But when the nasal passages are blocked, the patient breathes through his mouth more often, which creates some discomfort. Headaches may occur due to lack of oxygen or dry mouth. Breathing difficulties persist for up to 2–3 weeks, and sometimes up to 2 months.

In the first week after plastic surgery, the sutures on the columella and at the base of the tip of the nose are treated with antiseptics. To prevent the formation of crusts and mucus while wounds are healing, the nasal cavity is washed with saline solution. On the 7th day, the plaster splint and silicone splints are removed. Swelling may persist for up to 2 weeks.

A month after the operation, signs of surgical intervention disappear. The tissues of the nose are strengthened, and its shape takes on its final form. Performing physical procedures (magnetic and phototherapy, electrophoresis, microcurrent lymphatic drainage) will speed up the rate of recovery. After a year, scar tissue will finally form.

Deterioration and inflammation during recovery and rehabilitation occur when the patient does not act contrary to the advice and prescriptions of the doctor.

Tips from a plastic surgeon for quick rehabilitation

To prevent complications, it is necessary to follow the recommendations of the plastic surgeon.
Undergo therapy to prevent bacterial infection and fungal development, and properly treat sutures. Ointments based on arnica extract, Lyoton 100 (for eyelids), and Troxevasin will help get rid of swelling. And blood thinners (aspirin, ibuprofen) will speed up recovery. Nicotine makes it difficult for oxygen to pass through blood vessels, so temporarily quitting smoking helps wounds heal faster.

Surgeons' recommendations after surgery:

• for the first 2 days, warm drinks and food are required, limit the intake of spicy, too cold and hot foods;
• do not remove the plaster cast, do not let it get wet;
• limit visits to baths, saunas, beaches and solariums.
• sleeping only on your back is allowed for 2 weeks;
• Avoid tilting your head forward and limit physical activity and stress;
• for people with vision problems, it is worth replacing glasses with lenses during the recovery period (6 weeks) to reduce pressure on the bridge of the nose and prevent the appearance of “dents”;
• carry out a preventive examination 2 times a week, and after removing the splint once a month for six months, and a year later, go to the doctor for a follow-up examination.

When will the visible result appear?

The first changes are visible a week after the splint is removed. You can evaluate the new shape of the nose after 2-3 months. The final result will appear in six months, when the nasal tissue is restored.

Technique of the operation

IMPORTANT! During preliminary consultations, the doctor discusses with the patient his wishes for nose correction. If necessary, the approximate result of the operation is simulated on a computer.

The operation is performed under anesthesia and consists of several successive stages.

1. Providing access. All incisions are made inside the nasal passages. Their location and size depends on the specific task.
2. Partial peeling and stretching of tissues.
3. Working with nasal structures: resection, suturing, shape correction. If necessary, the surgeon uses pieces of cartilage from the patient's nasal septum as implants. In some cases, when there is not enough cartilage material in the nasal cavity, the patient's ear and rib cartilage can be used as cartilage implants.
4. Returning all tissues to their place, layer-by-layer sutures.
5. Fixing the nose with a plaster cast.

Which plastic surgery do you prefer?

The specialist determines whether the intervention should be carried out openly or closed. It takes a number of factors into account:

• Own qualifications. When internal structures are hidden, there is no direct visibility of manipulation. Therefore, this method is chosen by more experienced surgeons.
• Severity of defects. In some cases, imperfections can only be eliminated using an open method, for example, when installing endoprostheses.
• Scope of intervention. Large-scale operations are performed in an open manner, for example to eliminate a concave area.
• Past operations. If a correction has already been made, and its results did not satisfy the patient, an open technique is preferable for repeated intervention.

! Rhinoplasty in our clinic - more details about the procedure, prices, reviews, before and after photos

Information materials on the site are posted for informational purposes, not self-medication. Any plastic surgery is a surgical intervention. When deciding to have surgery, be sure to consult with a qualified professional.

Advantages of surgery at the GALAXY Beauty Institute

The constant development of closed rhinoplasty technology makes it possible to perform any type of nose shape correction. Doctors at the GALAXY Beauty Institute use unique proprietary techniques and original developments. They regularly improve and hone their skills. Thousands of successful operations and satisfied patients speak for themselves. Closed access has many advantages.

• There are no scars after the operation - the nose looks completely natural.
• The tip of the nose does not sag over time, since the supporting function of the collumella is preserved.
• During manipulations, the surgeon sees the result of his work, since the skin remains in place.
• The blood supply to the tip is preserved in full, since the collumella arteries do not intersect.
• The operation is performed using the most gentle method possible, since the skin is not cut and is not lifted above the structures of the nose.
• Fast rehabilitation. A little more than a week for recovery - and you can evaluate the first result. Within a month, the patient returns to his usual lifestyle, and within 6-8 months the final result is assessed.

Every patient of the GALAXY Beauty Institute deserves the best. The vast experience of surgeons, a lot of proprietary developments and modern equipment of operating rooms make it possible to cope with the most complex tasks, including revision rhinoplasty.

Preparing for surgery

Initial consultation

During the consultation, the plastic surgeon examines the nose and studies its features.
After listening to the patient’s wishes, the doctor performs computer modeling with 3D visualization of the future shape of the nose. Before the operation, clinical and laboratory tests are prescribed:

• hardware diagnostics - ECG, fluorography, radiography;
• blood sampling for general and biochemical analysis, testing for hepatitis, HIV, determination of the Rh factor and coagulogram;
• Analysis of urine.

After a consultation, obtaining the results of laboratory tests and diagnostic studies, the plastic surgeon outlines a surgical plan. The patient is referred to other specialized specialists, including an anesthesiologist and psychologist, if necessary.

Restrictions before correction

Avoid alcohol and medications that affect blood clotting, such as hormonal contraceptives and aspirin. Keep smoking and use of cosmetics to a minimum. Avoid tanning and solariums to reduce the risk of swelling. Replace your glasses with lenses; you cannot use them for 1.5 months. On the appointed day of surgery, it is permissible to eat a light meal.

Rehabilitation

After closed rhinoseptoplasty, rehabilitation of all structural elements, including bones and cartilage, is necessary. A long and traumatic operation requires recovery of 12 days, and sometimes up to two weeks. The open type of intervention involves increasing the rehabilitation period by another 2 to 3 days. If the procedure is done after 40 years, the wound healing period increases. It depends on the individual characteristics of the patient and his well-being. If the procedure is performed using endoscopic methods, then rehabilitation lasts only 5–7 days.

Turundas must be removed from the sinuses after 2 days, and plaster casts must be removed after 7 days. Swelling goes away in 3–4 days. During the entire rehabilitation period, you cannot wear glasses, take a hot bath, or go to the sauna or bathhouse. Only after complete restoration of nasal sensitivity can you gradually return to your usual routine of life.

What anesthesia is used

For some reason, patients believe that closed rhinosurgery can be performed under local anesthesia. This is impossible. The operation is quite long (up to 3 hours) and involves many manipulations in the facial area.

Rhinoplasty is performed under general (endotracheal) anesthesia. Modern general anesthesia is quite easily tolerated by patients even with increased sensitivity to some of its components.

Reviews

Anton : “After an accident 6 years ago, I was left with a crooked nose. It looked bad and it was difficult to breathe. Six months ago I had closed rhinoplasty. I felt like a different person!”

Lydia : “My nose has not suited me since childhood - its curvature was striking and spoiled my face, so it was not difficult to decide on surgery. At the consultation, the doctor advised me to have closed rhinoplasty. I saved up some money and went to the clinic. The result is amazing! I’m very pleased.”

Daria : “I was diagnosed with a deviated nasal septum and was told that I would have to have surgery. Outwardly it is not noticeable, but I was plagued by frequent allergies and a chronic runny nose. My plastic surgery was performed by a first-class surgeon with a good reputation, which inspired confidence in the positive outcome of this important procedure. When the plaster was removed, terrible bruises and swelling were discovered that lasted about ten days. But now I’ve forgotten what a runny nose is.”

Technical stages

Closed rhinoplasty includes several stages:

1. Skin incisions. Incisions are made on both sides of the vestibule of the nose to access the anatomical structures

The length of the partition is reduced

2. Working on the bridge of the nose
3. Lateral dissection of the patient's nasal bone
4. Formation of the tip and wings of the nose
5. Tamponade is performed
6. A plaster splint is placed on top to fix the result.

Possible complications

Depending on the individual characteristics of the person, some complications may arise after rhinoseptoplasty:

• Allergic reaction to anesthesia.
• Bleeding from the nose. Occurs when small vessels and capillaries are damaged.
• Swelling of the sinuses. Occurs when the operation is complicated or when its sequence is violated.
• Loss of smell. Associated with nerve damage during a closed type of operation.
• Infection. Often occurs when a course of antibiotics is not prescribed.
• The appearance of spider veins in the nasal area. Develops with deep damage to the capillary system.
• Pigmentation.
• Tissue necrosis. Occurs as a result of a medical error or when the functioning of body systems is disrupted.