Comparison of Various Rhinoplasty Techniques and Long-Term Results

Overview

Rhinoplasty can be done through an external incision across the columella, entirely through the nostrils, or through a hybrid the authors call open rhinoplasty without transcolumellar incision. This paper reports one group's experience with all three between 1999 and 2013 and discusses their modifications to each.

Sections of note

• 1,526 patients in total between 1999 and 2013.
• 1,131 had open rhinoplasty with a transcolumellar incision.
• 219 had open rhinoplasty without a transcolumellar incision.
• 176 had the endonasal approach, done entirely inside the nose.
• Average follow-up approximately four years. 4 percent of patients required revision surgery.
• Patient satisfaction exceeded 90 percent for all three techniques.

What it means for a patient

• Roughly one patient in 25 in this large series had a second operation, and more than nine in ten were satisfied whichever approach was used.
• The endonasal approach leaves no external scar and took less time, and the authors report fewer complications, but it suits only selected noses.
• The standard open approach gives the most control but the authors list prolonged tip swelling and a scar on the columella as drawbacks.
• Retrospective single-centre experience with no randomisation, no breakdown of which patients were assigned to which technique, and no standardised satisfaction instrument named.

Why this paper matters

The open versus closed debate has run through rhinoplasty for decades and is usually argued with small series. Fourteen years and over 1,500 cases give an unusually long view, and the hybrid approach is presented as a way to keep exposure without the external scar. Because patients were not randomly assigned, the numbers describe outcomes rather than establishing that one technique is better.

Terms

• Transcolumellar incision: a small cut across the strip of skin between the nostrils, used to open the nose.
• Open rhinoplasty: an approach that lifts the nasal skin to expose the framework directly.
• Endonasal rhinoplasty: an approach performed entirely through incisions inside the nostrils, leaving no visible scar.
• Revision: a further operation to correct the result of the first.
• Tip edema: swelling of the nasal tip, which can persist for months after open surgery.
• Retrospective study: research reviewing records of operations already performed.