All rhinoplasty procedures are not created equal. This is to say that the procedure differs depending upon your needs as a patient. After the initial decision to undergo a rhinoplasty, the next step involves the help of your plastic surgeon to evaluate which type of rhinoplasty procedure is best for you.
There are four types of rhinoplasty procedures. Read below for an overview of each. When your doctor has decided which type of rhinoplasty best suits your needs, be sure to access Dr. Bennett’s Guide to Rhinoplasty articles to read an in-depth explanation of each of the procedures that will help prepare you for your surgery.
A closed rhinoplasty is the most common type of rhinoplasty and the one that Dr. Bennett chooses most often. All incisions are hidden inside the nose with no external scars. Lifting the soft tissue slightly upward, the bone and cartilage is accessible to perform the necessary changes.
The technical methods, once the inside structure of the nose is visualized for an open or closed rhinoplasty, are similar. There are several advantages to having a closed rhinoplasty, due to its less-invasive nature:
- Reduced nasal tissue irritation (due to the lack of a columellar incision)
- Reduced likelihood of the nasal-tip support reduction
- Smaller likelihood of post-operative edema
- Lessened detectable scarring
- Less time spent in the operating room
- Faster post-operative patient recovery
An open rhinoplasty has historically been the rhinoplasty for patients who need extensive work done to the nose. Your surgeon will make incisions in the skin between your nostrils underneath your nose. This area is called the columella. Next, the skin is lifted to reveal the inside of the nasal cavity, giving your rhinoplasty surgeon access to perform the necessary reshaping.
Where extensive grafting or when revision surgery is needed, you may require an open rhinoplasty. Some surgeons will choose open rhinoplasty as their primary method of surgery depending on the training and skill of the physician. Open rhinoplasty procedures are best for patients with the following issues:
- Collapsed valves from previous hump removal
- Genetic, structural deformities in the nose (i.e. cleft lip palate)
- Acquired deformities in the nose (i.e. severe trauma requiring grafting)
- Dissatisfaction with the cosmetic appearance of the nose after previous nasal surgery
After a surgeon performs an open rhinoplasty, the columella is sutured and the nose is taped for stabilization purposes. After the taping, a nasal split that has been sculpted especially for the nose is placed over the tape. The splint will help protect the delicate tissues of your new nose during the healing process. It will be removed approximately one week after the surgery.
A filler rhinoplasty is a less common type of nose surgery. It is non-surgical in nature and can be done by dermatologists, cosmetic surgeons, physician assistants as well as general plastic surgeons. No incisions are made, but rather, the injectable filler is used to correct minor imperfections in the nose. For example, a filler rhinoplasty is an option for those who desire minimal change to the nose. The most common types of “fillers” are Juvederm and Restylane. A drawback to choosing a filler rhinoplasty is that the results are not permanent. Scarring from fillers can be permanent and vessels can be obstructed causing necrosis of the nasal skin. Over time, the filler eventually absorbs back into the skin, effectively erasing the changes and requiring an additional procedure.
Revision rhinoplasty is a subsequent surgery after a primary rhinoplasty. Typically patients opt for a revision rhinoplasty if they are unhappy with the results of the primary rhinoplasty or if they seek further changes not originally desired in the primary rhinoplasty. Breathing difficulties uncovered or created by the primary surgery are fairly common. For most, a revision rhinoplasty is an option for those who desire a “touch-up.” Most surgeons have a revision rate of around 10-15%. If a doctor has no revision rate the patients are likely having another physician perform subsequent surgeries. The main reason for revision surgery is breathing difficulty or a bump or irregularity of the bridge of the nose.
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