Not all rhinoplasty procedures are performed the same way. Just as every patient is different, every nose reshaping surgery is slightly different. One of the biggest differences in surgeries is in where the surgeon decides to make the incisions. Depending on what a patient wants done to his or her nose, the procedure can be either open or closed.
During an open rhinoplasty, the incisions are made on the outside of the nose, across the vertical strip that divides the nostrils. During a closed rhinoplasty, the surgeon makes the incisions inside the nose. Each procedure has its advantages and disadvantages. Discussing what you want from the procedure will help you and your surgeon decide which is right for you.
What You Want Done
When considering rhinoplasty, it's important to think about what you want to change about your nose. Some people want to have a bump or hump removed from the middle part of their nose. Some want a wider nose, others want one that is narrower. In some cases, people want a combination of rhinoplasty to change the shape of their nose and septoplasty to fix functional or breathing problems.
You want to discuss your specific hopes and expectations with your surgeon. Some changes to the nose are better suited to the open procedure, as it gives the doctor a better view of the interior of the nose. Others are suitable for a closed rhinoplasty.
Some patients assume that closed rhinoplasty means less scarring and decide impulsively that it is the surgery for them. While a closed procedure will mean that the scars will be invisible from the start, that should just be a small consideration when weighing the pros and cons of open and closed surgery.
The incision made during an open procedure, also called an external rhinoplasty, is on the outside of the nose, it's important to understand that the incision usually heals well. A scar will be visible, but it is often concealed by the base of the nose. In many cases, the scar fades enough over time to be completely unnoticeable.
What Happens During Surgery
What happens during an open rhinoplasty is somewhat different than what happens during a closed surgery. During an open surgery, after the doctor makes the cut across the columella, or strip that divides the nostrils, the skin is lifted up, exposing the interior of the nose. From there, the surgeon is able to remove cartilage if needed, straighten the septum or add a graft to enlarge the nose.
Most often, patients who undergo open rhinoplasty receive general anesthesia. During a closed procedure, a patient can either receive general anesthesia or a local anesthetic. Since the closed procedure is typically less complicated than an open one, the entire process is performed generally in shorter time.
Recovery is similar after either an open or closed rhinoplasty, but the recovery time from a closed procedure might be shorter, since the incisions are inside the nose and the surgery is usually less complicated. In either case, you can expect to take about a week off from work to recover.
Your nose will most likely be in a splint during the first week. Some patients also receive nasal packing, which is gauze placed in the nostrils. Your nose will feel a bit stuffy, as if you have a cold. You might feel a bit of discomfort, especially the day after the surgery, and have swelling and bruising in the first few days.
After the first week, it's usually recommended that you wait a few more weeks before starting up exercise or other vigorous activities, whether you've had an open or closed surgery. Since everyone heals slightly differently, your surgeon will give you clear instructions to help you heal most effectively.
Working with an experienced surgeon is a must, whether you decide to go for an open or closed surgery. Dr. Nathan Nachlas is a double board certified surgeon who specializes in facial plastic surgery, particularly rhinoplasty.
For more information or to request a consult with Dr. Nachlas contact Sandy Friedman, Director of Patient Relations at 561-939-0909.