Endonasal Secondary Rhinoplasty Techniques

Overview

Most revision rhinoplasty today is done open, through a columellar incision. Shomorony and Friedman review the case for the endonasal route in secondary surgery. This is a narrative review; the abstract reports no patient numbers or outcomes.

Sections of note

• Revision surgery is difficult because of altered anatomy, lost support, complex 3D shape and varying scar.
• The open approach "dominates contemporary revision rhinoplasty practice."
• Stated advantages of endonasal revision: preserved skin-soft tissue envelope, preserved ligamentous support, less oedema, no external scar, a more natural look and feel.
• Suitability depends on appropriate patient selection.

What it means for a patient

• A revision does not always require an open operation; smaller corrections may be done from inside the nostrils.
• The trade-off is less direct visibility for the surgeon, so the choice depends on what needs fixing.
• The paper gives reasoning, not comparative results, so it cannot say which approach produces better outcomes.

Why this paper matters

It keeps the endonasal option on the table in a field that has shifted almost entirely to open revision. Limits: review, no data, authors are proponents of the technique.

Terms

• Endonasal (closed) approach: all incisions hidden inside the nose.
• Open approach: an incision across the columella allowing the skin to be lifted off the framework.
• Skin-soft tissue envelope: the skin and underlying layers covering the nasal skeleton.
• Ligamentous support: the natural fibrous attachments between nasal cartilages and skin.
• Oedema: swelling.