Primary Open Rhinoplasty

Overview

Rhinoplasty is described as one of the most challenging plastic surgery procedures and one of the top five aesthetic operations, with over 223,000 performed in 2016. This teaching article concentrates on the open approach and the principles the authors consider necessary for consistent results.

Sections of note

• Stated learning objectives: describe the operative technique for open rhinoplasty; summarize the steps of a component dorsal reduction; develop a plan for tip shaping and cephalic rotation of the tip; identify the need for alar base improvement and perform alar base surgery; demonstrate consistency, safety and predictability.
• Over 223,000 rhinoplasties were performed in 2016.
• Rhinoplasty may be performed by the open or the closed approach, each with advantages and disadvantages.
• This article focuses on the open approach.
• The authors describe successful rhinoplasty as beginning with thorough clinical analysis, defined goals, meticulous preoperative planning, precise execution, vigilant postoperative management, and critical analysis of one's own results.
• The article is accompanied by videos.
• No patient numbers, outcomes, complication rates, or follow-up are reported.

What it means for a patient

• Component dorsal reduction means the bridge is lowered by treating its bone and cartilage parts separately rather than in one cut.
• Cephalic rotation means turning the tip upward.
• Alar base surgery narrows the width across the nostrils and is treated as a distinct step.
• This is an educational review with no data, so it reports no results or complication rates.

Why this paper matters

Continuing education articles set what practicing surgeons are taught to do, so they record the current standard sequence for the open approach. The emphasis on self-critical review of one's own results is a stated part of that standard. The abstract carries no evidence about outcomes.

Terms

• Open rhinoplasty: Surgery using an external incision across the columella to expose the framework.
• Component dorsal reduction: Lowering the bridge by treating bone and cartilage separately.
• Cephalic rotation: Turning the nasal tip upward.
• Alar base: The width across the bottom of the nostrils.
• Primary rhinoplasty: A patient's first nose operation.