Cosmetic Surgery and Beauty Magazine #68

nose
approach was further popularised and refined by Dr Jack
Anderson, who wrote Open Rhinoplasty: An Assessment in
1982. Although the technique was initially used for first-time
rhinoplasty, towards the late 1980s the open technique
started to become more prevalent in secondary, or revision
rhinoplasty, encouraged by the work of Dr Jack P Gunter.
During open rhinoplasty, an incision is made at the
base of the columella – the tissue and skin that separate
the nostrils at the base of the nose. The nasal skin is then
carefully lifted back, allowing the surgeon to work on the
cartilage and tissue inside the nose.
Because the inner cartilage network and underlying
structure of the nose is exposed, the surgeon has greater
visibility than with closed rhinoplasty, and is able to work
on the inner structure of the nose with more precision and
freedom. Open rhinoplasty is therefore often chosen for
more complicated cases, where considerable work may be
required in order to achieve the desired outcome.
Because the nose is the most
defining characteristic of the
face, a slight alteration can result
in a great improvement
technique when he published the paper External Approach
to Rhinoplasty, detailing what has become known as ‘open
rhinoplasty’. Today, both open and closed techniques are
widely used by surgeons, each having their own relative
merits and disadvantages.
Although the end-goal is often the same – either to
build-up (augment) or reduce the size of the nose – the
two techniques differ primarily in their access to the nasal
structure. In open rhinoplasty, the surgeon will make a small
incision between the nostrils, and go on to make a number
of additional incisions inside the nose. Closed rhinoplasty,
on the other hand, involves incisions made only to the
interior of the nose.
Rhinoplasty for cosmetic purposes grew in popularity
throughout the 20th Century and, consequently,
techniques were continually evolving. However, it wasn’t
until Dr Goodman’s paper in 1973 that open rhinoplasty
as a technique became more readily available. This new
The open technique, for example, can be helpful
when performing cleft lip operations, or during revision
rhinoplasty when an earlier procedure has left a nose
pulled too high and structural grafts are required. In these
scenarios, surgeons will tend to favour open rhinoplasty
due to the extra visibility given by revealing the internal
structure of the nose.
The open technique also helps ensure the basic
foundation of the nasal structure is kept strong, facilitating
a natural-looking outcome. It also leads to a more stable
shape post-surgery, helping to safeguard against collapse.
Because an incision is made at the base of the columella,
the open technique will leave a small scar on the underside
of the nose. This will fade over time and, in most cases,
become barely noticeable. The patient may also experience
swelling, bruising and numbness for a more drawn out
period of time than with the closed approach to rhinoplasty.
Whereas the open technique may be used to tackle
complex cases, closed rhinoplasty is generally used to
address minor defects. The operation is much quicker,
typically taking between one and two hours – around half
the time taken to perform closed rhinoplasty and because
all incisions are made inside the nostrils, the procedure
does not result in visible scarring. Given this minimally
invasive approach, healing and recovery time is also less,
as are swelling, bruising and numbness of the nasal tip
post-surgery.
www.cosbeauty.com.au 55