APS Aesthetic Plastic Surgery · 2024

Sensory Changes in Nasal Subunits Following Open and Closed Rhinoplasty: A Randomized Controlled Trial

Altunal SK, Celik M, Kocer U, Kucukguven A.

PubMed 37438671 Publisher (DOI)Free full text (PMC)

What this paper says

In a randomized trial, open rhinoplasty caused measurable numbness of the tip and the area beneath it at one month which resolved by three months, while closed rhinoplasty caused no measurable sensory loss at any point.

Overview

Numbness of the nasal skin is common after rhinoplasty and can trouble patients. The closed technique involves less dissection, so the authors expected less sensory loss. They ran a randomized study comparing the two approaches using both an objective test and patient report. The nose was divided into seven zones and tested before surgery and at 1, 3, 6 and 12 months afterward.

Sections of note

Design: randomized controlled trial. Level of evidence II.
Seven nasal subunits assessed: nasion, rhinion, nasal tip, left alar wing, right alar wing, infratip lobule and columella base.
Objective testing used the Semmes-Weinstein monofilament test; patients also rated change on a three-point Likert scale.
In the open group, both objective and subjective testing showed significantly reduced sensation in the nasal tip and infratip lobule at one month, returning to normal by the third month.
In the closed group, no significant difference from preoperative sensation was found in any subunit at any time point.
The abstract does not state how many patients were enrolled or how they were allocated between groups.

What it means for a patient

Numbness after open rhinoplasty is real, measurable, confined to the tip area and temporary, resolving by about three months in this trial.
The closed approach produced no detectable numbness, consistent with its smaller dissection.
Sensation was followed to twelve months, so late or permanent loss would have been captured within that window.
Limits: the abstract gives no sample size, and the study measures sensation only, not appearance, breathing or satisfaction.

Why this paper matters

Randomized trials are rare in rhinoplasty, and this one addresses a specific worry patients raise before surgery. Having a time course to quote, roughly three months, changes the counseling conversation. Whether the sensory difference should influence the choice between open and closed for any given nose is a separate question.

Terms

Open rhinoplasty: surgery through an external incision on the strip between the nostrils.
Closed rhinoplasty: surgery through incisions inside the nose only, with no external scar.
Nasal subunit: a defined zone of the nasal surface, such as the tip or a nostril wing.
Semmes-Weinstein monofilament test: touching the skin with calibrated filaments to measure sensation.
Infratip lobule: the area just below the tip, above the columella.

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

Abstract

Background: Skin sensation changes are common after rhinoplasty and can be troublesome for patients postoperatively. The closed technique may be considered as causing less sensory loss compared to the open technique due to its conservative approach, minimal dissection and low tissue damage potential. A randomized study was planned to compare the sensory changes in the subunits of the nasal skin caused by the two main methods using objective and subjective parameters.

Methods: In the analysis of the patients, the nose was divided into seven subunits: nasion, rhinion, nasal tip, left alar wing, right alar wing, infratip lobule and columella base. Evaluations were done preoperatively and at the first, third, sixth and twelfth months postoperatively. Objective sensory evaluations were done using the Semmes-Weinstein monofilament test. The subjective sensory changes of each nasal unit were subjectively evaluated by the patients on a three-point Likert scale.

Results: Both objective and subjective evaluations showed a statistically significant decrease in sensation in the nasal tip and infratip lobule in the open group one month after surgery. In the closed group, no significant differences were observed between the preoperative and postoperative sensory values for nasal subunits across all periods.

Conclusion: While a decrease in sensation was observed in the tip and infratip lobule in the open technique by the first month postoperatively, this loss of sensation returned to a normal level by the third month. In the closed technique, however, no significant loss of sensation was detected in the postoperative period. In light of our findings, surgeons can have a better insight into postoperative sensory changes in the subunits of nasal skin which makes them more confident and reassuring when there are concerns regarding altered sensation after rhinoplasty. Level of Evidence II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).