What is Open Rhinoplasty?
Open rhinoplasty, also called external rhinoplasty, is an approach of rhinoplasty in which a small incision is made on the nose, over the columella between the nostrils, in addition to several other incisions inside the nose. The transcolumellar incision improves the surgical access to the nasal framework by allowing the surgeon to fold the nasal skin upward. This provides better visibility of the entire nasal framework, in its natural undisturbed alignment.
Indications of Open Rhinoplasty
Open rhinoplasty can be performed on a patient with thick or thin nasal skin. It is indicated in the following conditions:
- Major augmentation with tip, columellar, spreader and/or shield grafts
- Correction of complex nasal deformities such as cleft lip, palate, nasal deformity and deviated septum or nasal trauma
- Revision rhinoplasty
- Excision of nasal tumor
- Treatment of internal nasal valve dysfunction
- Nasal tip modification
- Surgical repair of septal perforations
- Rhinoplasty in non-Caucasian ethnic groups
Contraindications of Open Rhinoplasty
Open rhinoplasty is an elective surgery and is contraindicated in a patient with:
- Unstable mental status
- Unrealistic expectations from the surgery
- Intranasal drug abuse
- Co-morbid medical conditions
- Very thick nasal skin that increases the risk of permanent post-operative edema
- Nasal dysfunction with or without aesthetic deformity that may be treated with a closed approach
Advantages over Closed Rhinoplasty
Improved access to the nasal framework allows considerable technical advantage to the surgeon for good assessment as well as precise modification and stabilization of the nasal framework.
Disadvantages over Closed Rhinoplasty
Transcollumellar incision may leave an external visible scar and may cause columellar flap necrosis. Extensive dissection of the nasal framework also increases the operative time and the risk of scarring, nasal tip ,edema and numbness after the surgery. However, in the hands of an experienced surgeon, open rhinoplasty does not leave an obvious external scar.
