The Principles and Practice of Endonasal Rhinoplasty: Special Topics for Clinics in Plastic Surgery Journal

Rad AN, Bridges MA, Constantian MB.

What this paper says

Constantian's review of closed rhinoplasty argues that limiting dissection and recognising four common anatomical variants before surgery prevents the three patterns of secondary deformity.

Overview

This is a principles review by Mark Constantian, a long-standing advocate of endonasal rhinoplasty, with co-authors. It defines endonasal rhinoplasty as improvement through intranasal incisions only, without a transcolumellar cut, with limited soft-tissue and skeletal disruption. No patient data are given in the abstract.

Sections of note

Dissection is intentionally limited to reduce skin contraction and scar contracture.
Four common anatomical variants are said to predictably produce all three patterns of secondary deformity; the surgeon must identify and correct them preoperatively.
Respecting these principles is said to increase predictability and reduce dissatisfaction and reoperation.

What it means for a patient

In this school of thought, most bad results come from a few unrecognised anatomical starting points, not from the approach itself.
Less dissection means less swelling and less unpredictable scarring.
The review states principles; it does not present outcomes.

Why this paper matters

It is a concise statement of the Constantian philosophy that underlies much closed and preservation thinking. Limits: expert review, no data, the four variants are not named in the abstract.

Terms

Endonasal rhinoplasty: all incisions inside the nose.
Transcolumellar incision: the external cut used in open rhinoplasty.
Secondary deformity: a problem that appears after healing and may need revision.
Scar contracture: tightening of scar tissue that distorts shape over months.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Endonasal rhinoplasty is a minimally invasive approach in which esthetic and functional improvements are made solely through intranasal, without transcolumellar, incisions and with limited soft tissue and skeletal disruption. In addition to intentionally limiting surgical dissection, the rhinoplasty surgeon must…”

Excerpt; the full abstract is on PubMed.