Limited Incision Rhinoplasty: An Approach for All Primary and Revision Cases

Overview

The open approach, with an external incision, has dominated rhinoplasty because it gives direct visibility. The authors note that patient interest in closed and preservation rhinoplasty has revived endonasal techniques, meaning surgery done from inside the nose. They present a consecutive series using bilateral isolated modified rim incisions in both first time and repeat operations.

Sections of note

• Design: retrospective chart review of 100 consecutive patients at a single surgeon private practice, June 2020 to September 2022. Level of evidence IV. The senior author performs 100 percent endonasal rhinoplasty.
• Case mix: 84 primary, 11 secondary, 4 tertiary and 1 quaternary rhinoplasty.
• Isolated modified rim incisions were used in all cases, with a unilateral Killian incision added for septoplasty and vestibular stab incisions added for lateral osteotomy.
• 6 patients, 6.0 percent, required revision.
• All revisions were performed under local anesthesia.
• The authors describe the technique as easier to learn than traditional endonasal and arguably than open rhinoplasty.
• No aesthetic scores, patient questionnaires or complication data beyond revision rate appear in the abstract.

What it means for a patient

• The approach leaves no external scar on the strip between the nostrils, since all incisions sit inside the nostril rims.
• Sixteen of the 100 cases were revisions of previous surgery, including four third and fourth operations, so the technique was not limited to straightforward noses.
• A 6 percent revision rate is within the range reported for rhinoplasty generally, and all revisions here were minor enough for local anesthesia.
• Limits: one surgeon who uses only this approach, no comparison group, no patient reported outcomes, and no stated follow up length.

Why this paper matters

The open versus closed debate has run for decades, with the open approach winning on visibility and the closed on tissue preservation. A consecutive series including revision cases tests whether the closed approach can cover the full range. Without a comparison group or outcome scores, it establishes feasibility rather than superiority.

Terms

• Endonasal or closed rhinoplasty: surgery through incisions inside the nose only.
• Open rhinoplasty: surgery through an external incision on the strip between the nostrils.
• Rim incision: an incision just inside the nostril rim.
• Killian incision: an incision inside the nose used to reach the septum.
• Lateral osteotomy: a cut along the side wall of the bony nose.
• Revision rate: the proportion of patients needing a further operation.