Preservation Rhinoplasty: Open or Closed?

Overview

Preservation rhinoplasty was initially performed through the open approach, but the author judged a closed approach might benefit certain patients. A total of 162 primary rhinoplasty cases performed between May and November 2020 were reviewed retrospectively, of which 100 had at least one year of follow up at intervals of 1 week, 1 month, 3 months and 1 year.

Sections of note

• Retrospective study; 100 patients with at least 1 year of follow up.
• Fifty six patients had an open approach and 44 a closed approach.
• Eighty three patients had preservation of the dorsal soft tissue covering, including all closed cases.
• Sixty seven patients had dorsal preservation, 38 with surface techniques and 29 with impaction techniques.
• Thirty three patients had structural rhinoplasty with piezoelectric bone cuts and middle vault reconstruction, all performed open.
• Four revision surgeries were necessary.
• The closed approach is favoured for thin skin, minimal bridge modification, foundation preservation techniques, less complex tip deformities and overprojected noses.
• The open approach is favoured for extensive bridge modification, S-shaped nasal bones, complex tip deformities and tip augmentation.

What it means for a patient

• Both routes are used within preservation surgery, and the choice depends on skin thickness, how much the bridge must change, and how complex the tip is.
• Closed means no external scar; open means an incision across the strip between the nostrils.
• Structural cases requiring bridge rebuilding were always done open.
• This is one surgeon's series over seven months with no comparison of outcomes between the two approaches.

Why this paper matters

The open approach became standard for its exposure, and preservation techniques revived the argument for operating inside the nose. This paper sets out selection criteria drawn from one surgeon's practice. Whether results differ between the two approaches is not measured here.

Terms

• Preservation rhinoplasty: keeping and repositioning existing structures rather than removing and rebuilding.
• Open approach: surgery through an incision across the columella, lifting the nasal skin.
• Closed approach: surgery through incisions inside the nose only.
• Surface technique: reshaping the surface of the bridge rather than lowering the whole framework.
• Impaction technique: lowering the whole framework into the face.
• Component reduction: taking the hump down piece by piece, the conventional method.